Low bone mineral density and risk of fracture in white female nursing home residents

JAMA. 2000 Aug;284(8):972-7. doi: 10.1001/jama.284.8.972.

Abstract

Context: Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear.

Objective: To assess the relative contribution of low BMD to fracture risk in nursing home residents.

Design: Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up.

Setting: Forty-seven randomly selected nursing homes in Maryland.

Patients: A total of 1427 white female nursing home residents aged 65 years or older.

Main outcome measure: Documented osteoporotic fracture occurring during follow-up as a function of baseline BMD measurements higher vs lower than the median, and after controlling for demographic, functional, cognitive, psychosocial, and medical factors.

Results: A total of 223 osteoporotic fractures occurred among 180 women. Low BMD and transfer independence were significant independent risk factors for fracture in this nursing home sample (P<.001) and the 2 factors acted synergistically (P =.06) to further increase fracture risk. Compared with women whose BMD was higher than the median (0. 296 g/cm(2)), those whose BMD was lower than the median had an unadjusted hazard ratio for risk of fracture of 2.1 (95% confidence interval [CI], 1.5-2.8); women who were independent in transfer had a hazard ratio of 1.6 (95% CI, 1.2-2.2) compared with women dependent in transfer. Among residents independent in transfer, those with BMD below the median had a more than 3-fold increase in fracture risk compared with those with higher BMD (unadjusted hazard ratio, 3.1; 95% CI, 2.2-4.4). Among residents dependent in transfer, those with BMD below the median had a 60% increase in fracture risk (unadjusted hazard ratio, 1.6; 95% CI, 1.1-2.3). Adjustment for covariates did not alter the BMD-fracture relationship.

Conclusions: Our data indicate that low BMD and independence in transfer are significant predictors of osteoporotic fracture in white female nursing home residents. JAMA. 2000;284:972-977

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density*
  • Female
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / etiology
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Maryland / epidemiology
  • Nursing Homes / statistics & numerical data*
  • Osteoporosis / complications*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • White People*