Usefulness of bone density measurement in fallers.

Hubert Blain (1) , Yves Rolland , Olivier Beauchet (2) , Cédric Annweiler (3) , Claude-Laurent Benhamou , Athanase Benetos (4) , Gilles Berrut (5) , Maurice Audran (6) , Sauveur Bendavid (7) , Valérie Bousson (8) , Karine Briot (9) , Michel Brazier (10) , Véronique Breuil (11) , Laure Chapuis (12) , Roland Chapurlat (13) , Martine Cohen-Solal (14) , Bernard Cortet (15) , Patricia Dargent (16) , Patrice Fardellone (17) , Jean-Marc Feron (18) , Jean-Bernard Gauvain (19) , Pascal Guggenbuhl (20, 21) , Olivier Hanon (22) , Michel Laroche (23) , Sami Kolta (24) , Eric Lespessailles (25) , Brigitte Letombe (26) , Eric Mallet (27) , Christian Marcelli (28) , Philippe Orcel (29) , François Puisieux (30) , Patrick Seret (31) , Jean-Claude Souberbielle (32) , Bruno Sutter (33) , Florence Trémollières (34) , Georges Weryha (35) , Christian Roux (1) , Thierry Thomas (35)

1 Department of Geriatrics - Efficiency and Deficiency Laboratory
2 Département de Médecine Interne et Gérontologie clinique
3 Service de médecine interne et gérontologie clinique [Angers]
4 Service de médecine gériatrique
5 Service de médecine aïgue gériatrique [Nantes]
6 GEROM - Groupe d'Études Remodelage Osseux et bioMatériaux
7 Médecine générale
8 B2OA (UMR_7052) - Bioingénierie et Bioimagerie Ostéo-articulaires ; Biomécanique et Biomatériaux Ostéo-Articulaires
9 Caractérisation du Tissu Osseux par Imagerie : techniques et applications
10 Service de rhumatologie
11 Service de rhumatologie
12 Service de rhumatologie
13 LYOS - Physiopathologie, diagnostic et traitements des maladies osseuses / Pathophysiology, Diagnosis & Treatments of Bone Diseases
14 Os et articulations
15 Service de rhumatologie[Lille]
16 CESP - Centre de recherche en épidémiologie et santé des populations
17 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
18 CHU Saint-Antoine [AP-HP]
19 Centre de médecine gériatrique
20 Foie, métabolismes et cancer
21 Service de rhumatologie [Rennes] = Rheumatology [Rennes]
22 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
23 HAVAE - Handicap, Activité, Vieillissement, Autonomie, Environnement
24 Service de rhumatologie [CHU Cochin]
25 I3MTO - Imagerie Multimodale Multiéchelle et Modélisation du Tissu Osseux et articulaire
26 Hôpital Jeanne de Flandres
27 Centre de référence des maladies rares du calcium et du phosphore
28 Service de Rhumatologie [CHU Caen]
29 Service de rhumatologie
30 Service de gériatrie
31 Service de rhumatologie
32 laboratoire de physiologie
33 Institut Calot
34 Centre de ménopause
35 Service d'Endocrinologie [CHRU Nancy]

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.

Domaines: Sciences du Vivant [q-bio]

Hubert Blain, Yves Rolland, Olivier Beauchet, Cédric Annweiler, Claude-Laurent Benhamou, et al.. Usefulness of bone density measurement in fallers.. Joint Bone Spine, 2014, 81 (5), pp.403-8. ⟨10.1016/j.jbspin.2014.01.020⟩. ⟨hal-01128189⟩