CIRCUMSTANCES AROUND THE FALL IN A MULTINATIONAL HIP FRACTURE RISK STUDY - A DIVERSE PATTERN FOR PREVENTION

Hip fracture is a major public health problem, but with a potential fo r prevention. Data from a European multicentre study on hip fracture e pidemiology with a case control design, the MEDOS study, were used to describe and analyse circumstances around falls associated with hip fr acture. The study includes 2185 fracture cases age >50 years from 14 c entres in southern Europe: Portugal, Spain, France, Italy, Greece and Turkey. Information was collected by a standardized and validated ques tionnaire translated into six languages and administered by trained in terviewers. Circumstances around the fall were categorized according t o: (1) place, age group and time of day; (2) functional disability, co -morbidity; (3) drug consumption including alcohol; and (4) environmen tal factors. Possibilities for prevention were also analysed. High ris k falls were identified using seven reasonably well-established risk f actors, and similarly eight risk factors were used to identify high ri sk fallers. Selected trains of events were also studied. A pattern of great diversity was found both among the fallers and the environment i n which they fell and fractured the hip. Those with more than one fact or involved constituted only 14.7% of female and 19.7% of male fractur es. A majority of cases were not physically disabled before the fall. A majority (66.5%) fell and fractured their hip indoors and only 4.3% outside in darkness. Cardiovascular and cerebrovascular comorbidity we re observed with 4.9 and 7.8%, of falls respectively. Falls in a stair way comprised 11% of falls. The correlation between the number of the risk factors of the faller and in the environment was 0.07 and there w as no difference between males and females. The pattern of causality b ehind falls that cause hip fracture and therefore of prevention compri ses many sometimes small groups and intricate time sequence. The resul ts suggest that global preventive strategies could presently not be im plemented. Instead, the pattern of prevention should include different target groups and be country and site specific. For the high risk gro up of institutionalized patients prevention can be implemented without delay. (C) 1998 Elsevier Science Ltd. All rights reserved.