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American Journal of Epidemiology Advance Access originally published online on December 8, 2008
American Journal of Epidemiology 2009 169(2):143-149; doi:10.1093/aje/kwn379
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Simply Ask Them About Their Balance—Future Fracture Risk in a Nationwide Cohort Study of Twins

Helene Wagner, Håkan Melhus, Rolf Gedeborg, Nancy L. Pedersen and Karl Michaëlsson

Correspondence to Dr. Karl Michaëlsson, Department of Surgical Sciences, Section of Orthopaedics, University Hospital, S751 39 Uppsala, Sweden (e-mail: karl.michaelsson{at}surgsci.uu.se).

Received for publication March 18, 2008. Accepted for publication June 25, 2008.

The principal causal components of an osteoporotic fracture are a fall and weakened bone strength. While bone quality measures have been frequently studied, the ability of simple measures of impaired balance to predict fracture risk has received less attention. Computer-assisted telephone interviews were conducted between 1998 and 2000 among 24,598 Swedish twins aged 55 years or older. Impaired balance at the time of interview was reported by 2,890 (12%) of the twins. Twin pairs who were discordant with regard to impaired balance were selected for analysis and followed for fractures through 2005. In a pairwise analysis, the odds ratio for hip fracture was 3.13 (95% confidence interval (CI): 1.62, 6.05) among twins with impaired balance as compared with their co-twins with normal balance. When previously recognized clinical risk factors for osteoporotic fracture were considered in the model, the odds ratio for hip fracture with impaired balance was 3.88 (95% CI: 1.40, 10.72). Approximately 40% of all hip fractures were attributable to impaired balance. The odds ratios for any fracture and any osteoporotic fracture for twins with impaired balance were 2.00 (95% CI: 1.29, 3.11) and 2.39 (95% CI: 1.49, 3.82), respectively. These results imply that self-reported impaired balance is a novel and readily assessed risk factor for future fractures in the elderly.

accidental falls; bone and bones; fractures, bone; frail elderly; musculoskeletal equilibrium; osteoporosis; risk factors; twins

Abbreviations: CI, confidence interval; OR, odds ratio; RR, relative risk

Editor's note: An invited commentary on this article appears on page 150.


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Related articles in Am. J. Epidemiol.:

Invited Commentary: A Fine Balance—Weighing Risk Factors Against Risk
Michael G. Walsh
Am. J. Epidemiol. 2009 169: 150-152. [Abstract] [FREE Full Text]  



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