Gambar 1.

Flowchart with inclusion and exclusion of study participants Table 1 Characteristics of Study Population Characteristic Total group (n = 277) % 72 67.1 (5091) 93 89 24 47 29 71.8 (40120) n 200 Fallers (n = 42) % 88 69.9 (5186) 254 91 246 100 61 119 72 19 47 33 71.9 (45 115) n 37 38 42 7 17 12 Non fallers (n = 235) % 69 66.6 (5091) 94 87 25 47 28 71.8 (40120) p-value n 163 0.013* 0.069 216 0.478 204 0.012* 54 102 60 0.438 0.945 0.323 0.945

Sex (female) Age, mean (range) years Living at home Low energy trauma Bone Mineral Density Normal (Tscore > -1) Osteopenia (Tscore -1 and > -2.5) Osteoporosis (Tscore -2.5) Weight, mean (range) kg Fracture type

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Characteristic

Total group (n = 277) % 43 48 5 3 17 12 32 9 9 5 59 30 10 31 34 18 18 1 n 119 134 15 9 47 33 89 26 26 13 164 84 28 85 95 50 50 2

Fallers (n = 42) % 36 57 5 2 24 19 41 14 12 7 71 43 10 50 31 24 29 0 n 15 24 2 1 10 8 17 6 5 3 30 18 4 21 13 10 12 0

Non fallers (n = 235) % 44 47 6 3 16 11 31 9 9 4 57 28 10 27 35 17 16 1 n 104 110 13 8 37 25 72 20 21 10

p-value

Upper extremity Lower extremity Trunk Multiple fractures Diabetes Orthostatic hypotension ** Medication Antihypertensive Benzodiazepines Antidepressive Anti-rheumatics Fall risk factors Mobility (TGUGT) 2 falls in previous year Use of benzodiazepines ADL difficulties Osteoarthritis Visual impairment Urinary incontinence Parkinson's disease
* significant: p < .05

0.430 0.305 0.922 0.899 0.200 0.235 0.337 0.473 0.750 0.649

134 0.080 66 0.055 24 0.891 64 0.003* 82 0.620 40 0.292 38 0.054 2 0.548

results of 252 subjects

** (20 mmHg drop in systolic BP and/or 10 mmHg drop in diastolic BP 1 minute after standing)

Mean (range)

Fall risk factor according to the Dutch guideline on fall prevention (TGUGT: Timed Get Up and Go Test: cut off at 12 seconds; ADL difficulties: fall risk if he or she had difficulties with a least two out of the three following questions of Gronigen Activity Restriction Scale: a) Can you, fully independently, go up and down the stairs; b) Can you, fully independently, walk outdoors (if necessary with a cane); and c) Can you, fully independently, take care of your feet and toenails?; Visual impaiment: cut off at visual acuity less than 0.4;

BMC Musculoskelet Disord. 2007; 8: 55. Published online 2007 June 28. doi: 10.1186/1471-2474-8-55. Copyright 2007 van Helden et al; licensee BioMed Central Ltd.

Table 2 Fall risk factors predicting the risk of falling within 3 months after a fracture: univariate analysis Total (n = 277) Women (n = 200)

Sex (female)

OR* 95% CI OR* 95% CI 3.27 1.238.66 -

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Total (n = 277) OR* Age (80+ yrs vs. 5059) 3.55 Mobility (TGUGT) 1.88 2 falls in previous year 1.92 Use of benzodiazepines 0.93 ADL difficulties 2.67 Arthrosis 0.84 Visual impairment 1.52 Urinary incontinence 2.07 Polypharmacy ( 5 pills/day) 2.58 Orthostatic hypotension 1.98 Cognitive impairment 1.67 Handgrip strength 1.95 FTBS feet together 1.43 FTBS semi-tandem stand 1.55 FTBS tandem stand 1.36 FTBS one leg stand 1.83 Chair stand test 1.66 95% CI 1.309.65 0.923.86 0.983.77 0.302.82 1.375.22 0.411.70 0.693.35 0.984.41 1.305.10 0.824.74 0.763.69 0.944.05 0.712.89 0.773.11 0.702.64 0.913.70 0.853.26

Women (n = 200) OR* 2.88 1.75 1.76 1.11 2.20 0.61 1.03 1.49 2.51 2.22 1.33 1.46 1.48 1.61 1.39 1.79 1.77 95% CI 0.998.40 0.793.85 0.863.64 0.353.55 1.074.56 0.281.31 0.422.58 0.673.31 1.195.28 0.885.60 0.553.21 0.643.31 0.683.21 0.753.45 0.682.85 0.813.95 0.853.68

*Values presented are crude OR's, significant OR's are printed in bold.

Fall risk factors according to the Dutch guideline on fall prevention.

Abbreviations and cut off values: Timed Get Up and Go Test (TGUGT) cut off at 12 seconds. Activities of Daily Living (ADL) difficulties: fall risk if he or she had difficulties with a least two out of the three following questions of Groningen Activity Restriction Scale: a) Can you, fully independently, go up and down the stairs; b) Can you, fully independently, walk outdoors (if necessary with a cane); and c) Can you, fully independently, take care of your feet and toenails? Visual impairment: cut off at visual acuity less than 0.4. Orthostatic hypotension: 20 mmHg drop in systolic BP and/or 10 mmHg drop in diastolic BP 1 minute after standing. Cognitive impairment : Abbreviated Mental Test score 8. Handgrip strength : For women, the cut-off point was < 30 kg, for men the cut-off point was < 50 kg. Four Test Balance Scale (FTBS): If the patient was not able to hold at least one of these positions for 10 seconds, this counted as one fall risk. Chair stand test: If the patient was not able to complete the test within two minutes this was regarded as a fall risk. BMC Musculoskelet Disord. 2007; 8: 55. Published online 2007 June 28. doi: 10.1186/1471-2474-8-55. Copyright 2007 van Helden et al; licensee BioMed Central Ltd.

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