Background/Purpose: Falls are among the leading external causes of mortality in the elderly. This issue acquires substantial importance in low-income countries where the population’s aging has been faster. Several clinical factors (including age, drugs and previous fracture) have been associated with increased fall risk. However, few studies performed a concomitant evaluation of clinical data, laboratory bone exams and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to fall risk in community-dwelling elderly. Our aim was to investigate the association between bone parameters and falls in a population-based prospective cohort of community-dwelling older adults.

Methods: Risk factors for recurrent falls were determined in 705 community-dwelling individuals (448 women and 257 men) aged ≥ 65 years. Specific questionnaire (clinical data), BMD and laboratory tests -including 25-hydroxyvitamin D (25OHD), intact PTH (iPTH) and serum cross-linked C-telopeptide (CTX) were performed at baseline and after a mean follow-up of 4.3±0.8 years. Individuals with recurrent falls (2 or more falls in the last year from the date of the second evaluation) were considered chronic fallers. Potential risk factors for recurrent falls were compared between fallers and non-fallers. Logistic regression models were used to used to identify independent predictors of recurrent falls. 

 Results: The frequency of chronic fallers was 16.5% (95% CI: 13.8-19.2). In multivariate analysis, independent risk factors for recurrent falls were visual impairment (OR = 2.49, 95% CI 1.30-4.74, p = 0.006), chronic use of psychotropic drugs (OR = 2.47, 95% CI 1.37-4.49, p = 0.003), previous fracture (OR = 2.78, 95% CI 1.48-5.20, p = 0.001), persistently low serum 25OHD (<20ng/mL) (OR = 1.71, 95% CI 1.10-2.64, p = 0.020) and loss of total hip BMD between the two assessments (OR = 1.21, 95% CI 1.17-1.25, p = 0.03 for each 5%-decrease).

Conclusion: In addition to traditional clinical risk factors for falls, significant loss of total hip BMD and persistently hypovitaminosis D were associated with recurrent falls in Brazilian community-dwelling elderly. In this way, recognizing these factors is essential to recommend preventive actions to reduce recurrence of falls and might improve the health outcomes in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequency-and-risk-factors-for-recurrent-falls-in-community-dwelling-elderly-a-population-based-prospective-cohort-study-in-brazil-the-sao-paulo-ageing-health-spah-study/