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Impact of a community-based osteoporosis and fall prevention program on fracture incidence
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
(Vadstena Primary Health Care Center, Vadstena, Sweden)
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-0279-5903
Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
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2005 (English)In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, 700-706 p.Article in journal (Refereed) Published
Abstract [en]

Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

Place, publisher, year, edition, pages
2005. Vol. 16, no 6, 700-706 p.
Keyword [en]
Fracture outcome, Fragility fractures, Prevention, Quasi-experimental
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13683DOI: 10.1007/s00198-004-1732-0OAI: oai:DiVA.org:liu-13683DiVA: diva2:21155
Available from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05
In thesis
1. Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes: The Vadstena Osteoporosis Prevention Project
Open this publication in new window or tab >>Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the effect of training programmes: The Vadstena Osteoporosis Prevention Project
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures.

Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI).

The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes

and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI).

A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. 50 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 788
Keyword
Vadstena Osteoporosis Prevention Project (VOPP), weight-bearing training study, physical activity, training programmes, elderly, forearm bone mineral density (BMD), balance-training
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-5212 (URN)91-7373-547-7 (ISBN)
Public defence
2003-05-08, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
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Supervisors
Note
On the day of the public defence the statuses of articles IV and V were Submitted and VI was ManuscriptAvailable from: 2003-05-19 Created: 2003-05-19 Last updated: 2013-09-05Bibliographically approved

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Grahn Kronhed, Ann-CharlotteKarlsson, NadineLöfman, OweTimpka, Toomas

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