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Joint Bone Spine. 2014 Oct;81(5):403-8. doi: 10.1016/j.jbspin.2014.01.020. Epub 2014 Apr 2.

Usefulness of bone density measurement in fallers.

Author information

  • 1Pôle de Gériatrie, Centre Antonin-Balmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34395 Montpellier Cedex 5, France; Laboratoire Movement to Health, Euromov, Université Montpellier 1, Site de Référence MACVIA-LR, Contre les Maladies Chroniques pour un vieillissement actif en Languedoc-Roussillon, 700, avenue du Pic-Saint-Loup, 34090 Montpellier, France. Electronic address: h-blain@chu-montpellier.fr.
  • 2Gérontopôle de Toulouse, Hôpital La Grave-Casselardit, CHU de Toulouse, Toulouse, France.
  • 3UPRES EA 4638, Service de gériatrie, CHU d'Angers, Angers, France.
  • 4EA4708 I3MTO, University of Orleans, Orleans, France.
  • 5Service de Gériatrie, CHU de Nancy, Inserm U1116, Université de Lorraine, Nancy, France.
  • 6Service de gériatrie, CHU de Nantes, Nantes, France.
  • 7Service de rhumatologie et GEROM, CHU d'Angers, Angers, France.
  • 8Médecine Générale, Paris, France.
  • 9Service de Radiologie Ostéoarticulaire, Hôpital Lariboisière, Paris, France.
  • 10Service de rhumatologie, hôpital Cochin, université Paris-Descartes, Paris, France.
  • 11Service de rhumatologie, Hôpital Nord, Amiens, France.
  • 12Service de rhumatologie, CHU de Nice-1, université Nice Sophia-Antipolis, Nice, France.
  • 13Service de rhumatologie, 35500 Vitré, France.
  • 14Service de rhumatologie, CHU de Lyon, Lyon, France.
  • 15Inserm U606, Université Paris-Diderot Paris 7, hôpital Lariboisière, Paris, France.
  • 16Service de gérontologie, hôpital Broca, université Paris Descartes, Paris, France.
  • 17Université Paris-Sud, UMRS 1018, Villejuif, France.
  • 18Inserm ERI 12, service de rhumatologie, CHU d'Amiens, Amiens, France.
  • 19Service de chirurgie orthopédique, hôpital Saint-Antoine, Paris, France.
  • 20Centre de médecine gériatrique, CHR d'Orléans, Orléans, France.
  • 21Inserm UMR U 991, Service de rhumatologie, CHU de Rennes, Rennes, France.
  • 22Service de gérontologie, hôpital Broca, Paris, France.
  • 23Centre de Rhumatologie, CHU Purpan, Toulouse, France.
  • 24Service de gynécologie médicale et médecine du couple, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France.
  • 25Centre de référence des maladies rares du calcium et du phosphore, CIC Inserm 204, CHU de Rouen, Rouen, France.
  • 26Service de rhumatologie, hôpital Côte-de-Nacre, Caen, France.
  • 27Service de rhumatologie, hôpital Lariboisière, Paris, France.
  • 28Service de Gériatrie, CHU de Lille, Lille, France.
  • 29Service de rhumatologie, Angers, France.
  • 30Laboratoire d'Explorations Fonctionnelles, Inserm U845, Hôpital Necker-Enfants-Malades, Paris, France.
  • 31Service de chirurgie orthopédique des adultes de l'Institut Calot-de-Berck, Berck-sur-Mer, France.
  • 32Centre de ménopause, hôpital Paule-de-Viguier, Toulouse, France.
  • 33Service d'endocrinologie, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
  • 34Inserm U1059, Service de Rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.

Abstract

The objective of this systematic literature review is to discuss the latest French recommendation issued in 2012 that a fall within the past year should lead to bone mineral density (BMD) measurement using dual-energy X-ray absorptiometry (DXA). This recommendation rests on four facts. First, osteoporosis and fall risk are the two leading risk factors for nonvertebral fractures in postmenopausal women. Second, BMD measurement using DXA supplies significant information on the fracture risk independently from the fall risk. Thus, when a fall occurs, the fracture risk increases as BMD decreases. Third, osteoporosis drugs have been proven effective in preventing fractures only in populations with osteoporosis defined based on BMD criteria. Finally, the prevalence of osteoporosis is high in patients who fall and increases in the presence of markers for frailty (e.g., recurrent falls, sarcopenia [low muscle mass and strength], limited mobility, and weight loss), which are risk factors for both osteoporosis and falls. Nevertheless, life expectancy should be taken into account when assessing the appropriateness of DXA in fallers, as osteoporosis treatments require at least 12months to decrease the fracture risk. Another relevant factor is the availability of DXA, which may be limited due to geographic factors, patient dependency, or severe cognitive impairments, for instance. Studies are needed to better determine how the fall risk and frailty should be incorporated into the fracture risk evaluation based on BMD and the FRAX® tool.

Copyright © 2014. Published by Elsevier SAS.

KEYWORDS:

Bone mineral density; Dual-energy X-ray absorptiometry; Falls; Frailty; Management; Osteoporosis; Recommendations

PMID:
24703626
[PubMed - indexed for MEDLINE]
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