RESEARCH REPORT PLATFORM PRESENTATION

RISK FACTORS OF FRACTURES AMONG OLDER PERSONS IN A FINNISH MUNICIPALITY – A POPULATION-BASED 12-YEAR FOLLOW-UP . Piirtola M^1,2, Vahlberg T³, Isoaho R^1,4, Aarnio P⁵, Kivelä S^1,5,6; ¹Department of Family Medicine, University of Turku, Turku, Finland. ²Härkätie Health Centre, Lieto, Finland. ³Department of Biostatistics, University of Turku, Turku Finland. ⁴Pori Health Centre, Pori, Finland. ⁵Satakunta Central Hospital, Pori, Finland. ⁶Unit of Family Medicine, Turku University Hospital, Turku, Finland

PURPOSE: The purpose of this study was to analyse gender specific risk factors of fractures among persons 65 years or older during the follow-up of 6 and 12 years. RELEVANCE: Long-term risk factors of fractures should been identified and screened in physiotherapy practice in order to reduce falls and fractures among older persons. PARTICIPANTS: 1177 subjects aged 65 years or older (482 men, 695 women), mean age 73 years (range 65-97), living in the municipality of Lieto, located in South-Western Finland. METHODS: A true population-based cohort study started in October 1990. Information about fractures among 1177 participants was collected individually from health care registers during 1991-2002. The mean follow-up period was 8.5 years. ANALYSIS: Subjects having sustained at least one fracture during 6 or 12 year follow-up period were compared with subject with no fractures at the same follow-up period. Risk factors of fractures were analyzed using Poisson regression model. All analyses were done separately for men and women. RESULTS: In multivariate Poisson regression analyses the independent risk factors among women during six years of follow-up were weak hand grip strength (Relative Risk (RR) 2.2, 95% confidence intervals (95% CI) 1.2-4.0) low BMI (body mass index) (RR 2.1, 95% CI: 1.3-3.4), poor cognitive ability (RR 2.4, 95% CI: 1.1-5.7), and in a chest radiogram observed compression fracture in one or more thoracic vertebras (RR 2.3, 95% CI: 1.4-3.8). In 12 years of follow-up the risk factors were weak hand grip strength (RR 2.2, 95% CI: 1.4-3.4), low BMI (RR 2.0, 95% CI: 1.3-2.8), and in the chest radiogram observed compression fracture in one or more thoracic vertebras at base line (RR 2.0, 95% CI: 1.4-3.0). Among men a high amount of depressive symptoms (RR 3.6, 95% CI: 1.7-7.6), (RR 2.0, 95% CI: 1.2-3.4), and in the chest radiogram observed compression fracture in one or more thoracic vertebras (RR 4.1, 95% CI: 1.8-9.6), (RR 3.4, 95% CI: 1.8-6.2) were related to the risk of sustaining at least one fracture during both six and 12 years of follow-ups, respectively. CONCLUSIONS: The Risk factors of sustaining fractures among persons 65 years or older varied by gender. In the chest radiogram observed compression fracture in one or more thoracic vertebras at base line was an independent risk factor in both genders. IMPLICATIONS: This new information about predictive, independent, and gender specific risk factors provides new possibilities in prevention of falls and fractures in clinical everyday work. More education for physiotherapist and all health care professionals is needed. KEYWORDS: Risk factors, fractures, older people. FUNDING ACKNOWLEDGEMENTS: The baseline study was supported by The Academy of Finland, The Yrjö Jahnsson Foundation, and The Finnish Anti-Tuberculosis Association. The follow-up study of fractures was supported by The La Carita Foundation, The Finnish Cultural Foundation; The Regional Fund of Varsinais-Suomi – The Laina and Aarne Alitalo, The Juho Vainio Foundation, grants from Satakunta Hospital District and Lieto Health Centre, and the scholarship fund of the Ageing, Wellbeing and Technology graduate school. CONTACT: maarit.piirtola@utu.fi

ETHICS COMMITTEE: The Joint Ethics Committee of the Turku University and Central Hospital and the Finnish Ministry of Social Affairs and Health.