Inability to rise from a chair without using hands strongly predicts osteoporotic hip fracture risk

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Inability to rise from a chair without using hands strongly predicts

osteoporotic hip fracture risk

Oct 29, 2004 Mann

San , TX - The inability to rise from a chair without using the hands

is a predictor that a patient is at high risk for osteoporotic hip fracture,

according to new research highlighting easily measurable fracture risk

factors that supplement bone mineral density (BMD) testing [1]. Other simple

measures can help identify patients at increased risk for vertebral, wrist,

or rib fractures. The new study was presented at the American College of

Rheumatology 2004 meeting.

Bone mineral density testing alone may not represent the most completely

accurate way to assess fracture risk.

" Bone mineral density testing alone may not represent the most completely

accurate way to assess fracture risk, " researcher Dr Ioannidis

(McMaster University, Hamilton, ON) tells rheumawire. " The usefulness of

risk factors should focus on the clinical setting in a way that promotes

easy measurement with applicability to all patients. " In fact, Ioannidis et

al found that gauging proprioception strength and coordination by examining

a patient's ability to rise from a chair without using the hands is the most

" significant, convenient, and predictive " risk factor for hip fracture, with

an odds ratio of 3.6.

Of 7 fracture risk factors analyzed, 6 prove useful

The new study culled data from the multisite Canadian Database of

Osteoporosis and Osteopenia (CANDOO) registry of 3653 postmenopausal women.

This registry was developed to create a comprehensive dataset related to

osteoporosis. The main study objective was to examine the effectiveness of

easily measurable risk factors for new wrist, rib, hip, and vertebral

fractures. During the study period, 99 women sustained a wrist fracture, 64

sustained a rib fracture, 158 had a vertebral fracture, 40 had a new hip

fracture, 53 experienced multiple fractures, and 2065 had no fractures.

The researchers examined 7 possible predictors, including age (<65, 65-69,

70-74, 75-79, 80+ years), rising from a chair without using the hands,

weight (<57 kg, >57 kg), maternal history of hip fracture, prior fracture

that occurred after age 50, total hip t-score (>-1, -1 to >-2.5, <-2.5), and

current smoking status.

Risk factors vary by fracture site

" It is of critical importance that physicians at all levels of care be able

to effectively and efficiently identify those individuals at increased risk

of future fracture. Fracture represents the single most important clinical

event in patients with osteoporosis, yet few if any premonitory symptoms are

present, " the investigators said. " This study has shown that there exists a

variety of predictors of future fracture besides BMD that can be easily

assessed by a physician. Of greatest interest is the fact that decreased

mobility/strength, as represented by an inability to rise from a chair, is

perhaps the most readily identifiable significant risk factor for hip

fracture and can be easily incorporated into routine clinical practice. "

The study showed that:

* Hip fracture is over 3 times more likely in patients who cannot rise

from a chair without using their hands.

* Vertebral fractures are 1.6 times more likely in patients with low

body weight (<57 kg) and nearly twice as likely in patients who smoke or who

are between 75 and 79 years of age.

* Wrist fractures are 1.71 times more likely in women with low body

weight and nearly twice as likely if the patient has had any type of

fracture after age 50.

* Rib fractures are twice as likely if the patient has had any type of

fracture after age 50 and nearly 3 times as likely if the patient's mother

had a history of hip fracture.

Interestingly, previous fracture did not increase the risk of hip fracture,

but this may be due to the small sample size. Only 40 people in the cohort

experienced a hip fracture during the study period.

Ioannidis points out that many of those at increased risk of fracture remain

undiagnosed. " Over the years, the identification of risk factors has

improved among general practitioners, but there is still room for

improvement, " he says.