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- Nordvall, Helena, 1950-, et al.
(författare)
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Can a risk factor questionnaire for osteoporosis and functional tests predict low bone mineral density or falls in patients with a distal radius fracture?
- 2009
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 11:2, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective cohort study, 141 patients with a recent radius fracture [135 women (66±9.2 years) and six men (72±6.3 years)] were studied using bone mineral density (BMD) measurements, a risk factor questionnaire, a fall diary, functional tests of dynamic and static balance, and a one-leg rise from a chair test. The mean BMD T-score was -1.97. The results of the one-leg rise test were significantly associated with dynamic and static balance, but none of the functional tests was associated with the number of falls. Forty of 117 patients fell prospectively, 77 of them did not. Decreased height and cigarette smoking were the only risk factors, which significantly predicted low BMD. All risk factors were estimated to explain osteopenia and osteoporosis to an extent of 27%. The functional tests and the risk factor questionnaire seem to be of limited value for identifying people with a radius fracture who are at risk of falling or to have early osteoporosis. If functional tests on musculoskeletal function are considered for older and more frail, the one-leg rise test may be sufficient. Keywords: Bone mineral density (BMD); functional tests; one-leg rise test; radius fracture; risk factors for osteoporosis
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| 2. |
- Nordvall, Helena, 1950-
(författare)
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Factors in secondary prevention subsequent to distal radius fracture : Focus on physical function, co-morbidity, bone mineral density and health-related quality of life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary. The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis. Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up. Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls. The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.
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| 3. |
- Nordvall, Helena, 1950-, et al.
(författare)
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Pay attention to co-morbidity after a recent radius fracture : a longitudinal case-control study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Material and methods: Mortality and co-morbidity, as in the number of visits to in- or outpatient care facilities, were studied in 73 patients during the first three years after a radius fracture compared to controls, and health-related quality of life, using the SF-36 initially and three years later. Results: Four patients died but none among the controls, during the study period. There were statistically significantly more in-patient visits among the patients, due to other reasons than the radius fracture, but fewer out-patients visits at the hospital. The patients had a significantly lower Role Physical score in the SF-36 about three months after the fracture. This difference disappeared three years later.Conclusions: A higher need for in-patient care, indicating a worse general health, has to be taken into consideration when secondary prevention programs for patients with a radius fracture are designed and implemented.
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| 4. |
- Nordvall, Helena, 1950-, et al.
(författare)
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Secondary prevention after distal radius fracture : a prospective observational study of the effect of an exercise intervention
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This prospective observational study evaluated the effect of a four-week educational and exercise program, entitled the osteoporosis school. Two hundred and thirteen women with a distal radius fracture (mean age 66 years) were invited and 41 of them (mean age 64 years) accepted to join an exercise group (exercisers), 172 (mean age 66 years) declined and became a control group (non-exercisers). The intervention was followed by a one-year self-administrated exercise program. Bone mineral density (BMD), functional tests of dynamic and static balance, and leg strength were evaluated before and after the one-year intervention period and falls were registered in a fall diary. No statistically significant mean difference was found in dynamic or static balance between the exercisers and the non-exercisers. However, both groups showed improved balance (walking backwards and standing on one leg with eyes open over the study time (p<0.01). After the intervention, no significant difference was found between the groups in the one-leg rise test (p=0.494). The mean T-score was -1.859 at the baseline and -1.951 after intervention for the exercisers, and -2.0 and -2.064 for the non-exercises. There was no statistically significant difference in prospective falls between the exercisers and the non-exercisers (p= 0.272). Twelve of 41 exercisers (29.3%) and 37 of 172 non-exercisers (21.5%) reported one or more falls. Conclusion: Only 19% of the patients with a recent radius fracture accepted to participate in the osteoporosis school. The osteoporosis school with a 12-month home-based exercise program had no established effect on BMD, balance, leg strength or falls. This lack of proven efficacy for the secondary prevention of distal radius fractures, highlights the need for further research on better and more controlled interventions and for long-term randomised controlled follow-up studies.
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