Integrative Studies on Falls, Osteoporosis, and Fractures in Older People

Falls, osteoporosis, and fractures are three major problems of public health in Taiwan and other developed countries as their population age. There are no integrative works of intervention and healthcare on the three problems in elderly people. Falls and bone mineral density are the most important determinants of fractures. Currently, five osteoporosis self-assessment tools of the Fracture Risk Assessment Tool (FRAX), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Index of Risk (OSIRIS), Osteoporosis Self-Assessment Tool for Asians (OSTA), and Simple Calculated Osteoporosis Risk Estimation (SCORE) and quantitative ultrasonography (QUS) are potentially qualified to be an appropriate tool for screening osteoporosis in community-dwelling elderly people. The clinimetric properties of these tools are never compared with one another in the same population. Falls are associated with 96% of distal forearm fractures, 96% of proximal humeral fractures, 90% of hip fractures, and 25~60% of vertebral fractures in the elderly. Although lots of epidemiological studies on hip fractures have been conducted, relevant data on vertebral fractures, distal forearm fractures, and proximal humeral fractures are not provided. As for quality of life assessment, osteoporosis-specific scales are seldom used in patients with a fracture. This 3-year project will address the issues mentioned in the above. In the first year, a community screening study will be carried out to compare test-retest reliability and concurrent, predictive, and convergent validities of five osteoporosis self-assessment tools of FRAX, ORAI, OSTA, OSIRIS, and SCORE and the QUS. Whether the clinimetric properties of the six tools between elderly people in an urban area and those in a rural area remain similar will be examined as well. In the second year, three case-control studies will be conducted to determine the risk factors for the occurrences of vertebral fractures, distal forearm fractures, and proximal humeral fractures. In the third year, a longitudinal study will be conducted to compare changes in health-related quality of life during the first year after falling in elderly people who had fractured a vertebra, distal forearm, proximal humerus, and hip. Fracture type and other potential factors for changes in each domain of the European Foundation for Osteoporosis (QUALEFFO-31) and the short version of the World Health Organization Quality of Life (WHOQOL-BREF) will also be examined. Finally, for further interpreting these changes in each domain of the QUALEFFO-31 and WHOQOL-BREF, clinically meaningful changes (responsiveness) will be determined.