FALL SEVERITY AND BONE-MINERAL DENSITY AS RISK-FACTORS FOR HIP FRACTURE IN AMBULATORY ELDERLY

Objective.-To determine the relative importance of fall characteristic s, body habitus, and femoral bone mineral density (BMD) in predicting hip fracture in community-dwelling elderly. Design.-Prospective case-c ontrol study. Setting.-Community-based academic hospital. Participants .-A total of 149 ambulatory, community-dwelling fallers (126 women, 23 men) aged 65 years and older, including 72 case patients (fallers wit h hip fracture) and 77 control fallers (fallers with no hip fracture). Main Outcome Measures.-Fall characteristics, body habitus, femoral BM D. Results.-Significant and independent risk factors for hip fracture in both sexes were direction of the fall (adjusted odds ratio [OR], 5. 7; 95% confidence interval [CI], 2.3 to 14.0; P<.001); femoral neck BM D (a decrease of 1 SD; adjusted OR, 2.795% CI, 1.6 to 4.6; P<.001); po tential energy of the fall (an increase of 1 SD; adjusted OR, 2.8; 95% CI, 1.5 to 5.2; P<.001); and body mass index (a decrease of 1 SD; adj usted OR, 2.2; 95% CI, 1.2 to 3.8; P<.01). Importantly, the OR for the fall direction was unaffected by the addition or removal of BMD from the model. Conclusions.-We conclude that among elderly fallers-in most of whom hip BMD is already less than the fracture threshold-fall char acteristics and body habitus are important risk factors for hip fractu re and touch on a domain entirely missed by knowledge of BMD. These da ta suggest new targets for preventive therapy. In addition to the main tenance of bone density, reductions in fall severity (eg, by use of tr ochanteric padding or enhancement of muscle strength) may provide addi tional strategies for prevention of hip fracture in this age group.