Fracture risk assessment in nursing homes
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EDITORIAL
Fracture risk assessment in nursing homes Nicholas C. Harvey1,2 · Cyrus Cooper1,2,3
© European Geriatric Medicine Society 2020
The enormous burden of non-communicable chronic diseases consequent to an increasingly ageing demographic is a clear health priority worldwide, recognised by the World Health Organization in its recent “WHO Report on Ageing and Health” [1]. As populations age, the number of individuals who suffer from non-communicable chronic diseases such as dementia, cardiovascular conditions, osteoporosis and sarcopenia will increase. Using osteoporotic fracture as an example, these demographic changes are projected to result in a doubling in the number of individuals at high fracture risk from around 150 million in 2010 to nearly 300 million in 2040 [2] and the numbers of hip fractures worldwide similarly are expected to rise from 1.66 million in 1990 to 6.26 million annually by 2050 [3]. Osteoporotic fractures cost the EU €39 billion annually [4] and are associated with substantial morbidity and excess mortality [5]. Frail older persons represent a particularly high risk group, who may require institutional care in residential or nursing homes. This population are known to be at greater risk of fracture than comparable free-living individuals for a variety of reasons, including generally impaired musculoskeletal health resulting in decreased mobility, increased falls risk and lower BMD, with the adjunctive effects of comorbidities such as dementia and cardiovascular disease [5, 6]. Whilst this institutionalized population is typically at high fracture risk, there is little consensus about how best to risk stratify individuals within such an environment. Ihama et al., presented in this issue of European Geriatric Medicine, undertook a study of available fracture risk calculators * Cyrus Cooper [email protected] 1
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
2
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
3
NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
in a nursing home setting to ascertain their predictive value for the outcomes of falls and fractures [7]. As is not unusual, recruitment presented some difficulties in this old, frail, often demented population, and it is notable that only 217 (35%) of the 618 residents in 18 homes were enrolled and that of these 217 enrolled, 70% did not have mental capacity and so consent was obtained from a relative. This of course has implications for the ascertainment of self-reported clinical risk factors and indeed for incident events which were reported by the care home at 12 months. Importantly, there were 325 incident falls amongst the enrolled participants but only 10 fractures. Thus, the statistical power available to investigate the predictive value of the three risk calculators, together with that for the individual clinic
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