Risk of falls in patients with low bone mineral density
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Gerontologie+Geriatrie Original Contributions Z Gerontol Geriat https://doi.org/10.1007/s00391-020-01784-5 Received: 20 July 2020 Accepted: 26 August 2020 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020
Luis Möckel HSD Hochschule Döpfer, University of Applied Sciences Cologne, Cologne, Germany
Risk of falls in patients with low bone mineral density Analysis of placebo arms from clinical trials
Introduction Falls are a major risk factor for fractures [1–3] and it is estimated that up to 90% of hip fractures in older patients are the consequences of falls [4]. The International Osteoporosis Foundation (IOF) recommends preventing patients with osteoporosis from falling by measures, such as fall-proofing homes, strengthening muscles or maintaining a healthy diet [5]. It is well known that besides increasing age, patients with frailty and sarcopenia have a higher risk for falls and fractures [3, 6–8]. Particular medications, such as antidepressants, sleep aids and muscle relaxants can negatively impact the risk of falls and fractures [2]. In contrast, the osteoporosis medications denosumab and teriparatide have been shown to positively impact risk of falls in patients with low bone mineral density (BMD) [9, 10]. A recently published meta-analysis showed that osteoporotic patients treated with teriparatide had a 23% lower risk of experiencing falls [10]. Previous studies concluded that there is a relationship between muscle mass, frailty and BMD [11, 12]. A study analyzing the data of 106 older patients identified a significant association of BMD with frailty and pre-frailty by using a multiple linear regression model [12]. In addition, it was shown in older mice that osteocalcin, a protein synthesized by boneforming osteoblasts, is essential to prevent muscle loss [13], indicating a potential interaction between bone and muscle cells. Nevertheless, and to the best of my knowledge, analyses estimating the risk
of falls in patients with low BMD and osteoporosis based on data of clinical trials are seldom. Therefore, the objective of this analysis was to determine the risk of falls in patients with low BMD and osteoporosis using data from placebo arms of clinical trials. Further objectives were to identify potential associations between risk of falls with age, body mass index (BMI) and baseline BMD values.
Methods Study design This study was a retrospective analysis of placebo arms from clinical trials, indexed on study registry clinicaltrials.gov. Placebo-controlled studies investigating patients with low BMD and/or osteoporosis were taken from clinicaltrials.gov and included into this analysis if they fulfilled the following criteria: (1) placebo controlled, (2) number of falls reported for the placebo treatment period, and (3) patients with BMD T-score of –1.5 (or equivalent in g/cm2) at lumbar spine (LS), total hip (TH) and/or femoral neck (FN). Studies were excluded, (1) if they were conducted with children, juveniles and/or young adults, (2) if falls were only reported for sequential treatment perio
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