Risk factors for falls and fractures in elderly women. The Malmö OPRA study

Research output: ThesisDoctoral Thesis (compilation)


Approximately half of all women will sustain a fracture after the age of 50. Fractures may cause long-term disability and excess mortality. Identifying individuals at high risk of sustaining a fracture is important in the development of primary and secondary prevention strategies.

In this study, initiated to identify factors associated with a high risk of future fractures, 1 044 women, all 75 years old, were recruited from the general population of the city of Malmö.

A device for ultrasound measurements of the phalanges was compared with ultrasound measurements of the calcaneus and dual-energy X-ray absorptiometry (DXA) of the hip and spine. Ultrasound results of the phalanges were inferior to those of the other methods in the discrimination of women with and without previous fractures.

Self-assessed, previous physical activity was not associated with greater bone mass in old age. Present body weight had a much larger influence on bone mass than present physical activity level and muscle strength of the lower extremity.

A visual estimate of biological age was related to fall-associated variables but not to bone mass at baseline. Women with a high biological age had an increased risk of sustaining fracture and of mortality during the follow-up, which ranged between 3 and 6.5 years.

Ten different biochemical markers of bone turnover were measured in serum and urine at baseline. Three novel markers (serum tartrate-resistant acid phosphatase 5b and two urinary osteocalcins) had the highest fracture predictive ability during the follow-up. The predictive ability was independent of the results of a DXA measurement.

Vitamin D deficiency, as determined by serum 25-hydroxy vitamin D, was in this cohort associated with inferior self-assessed activity, balance and gait. A low 25-hydroxy vitamin D level was associated with prospective falls and fractures.

The results of this study show that in old age the effect of increased physical activity on bone mass is likely to be limited. Retaining body weight is likely to be important for maintaining bone mass. Part of the higher fracture incidence seen in women with low 25-hydroxy vitamin D is likely to be mediated through factors related to physical activity and postural stability. The novel biochemical markers provide additional information for fracture prediction. A high biological age is related to fall risk and is an important predictor of future fracture. By combining different risk factors, the prediction of fractures can be substantially improved.


  • Paul Gerdhem
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics


  • Fysiologi, Physiology, muskelsystem, Skelett, muscle system, Skeleton, Falls., Vitamin D, Bone turnover markers, Frail elderly, Body weight, Physical activity, Osteoporosis, Fractures, Bone density, reumatologi, rheumatology locomotion
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2004 Jan 9
  • Paul Gerdhem,
Print ISBNs91-628-5932-3
StatePublished - 2003
Publication categoryResearch

Bibliographic note

Defence details Date: 2004-01-09 Time: 10:15 Place: Universitetsklinikernas aula, Ing 35, Universitetssjukhuset MAS, Malmö External reviewer(s) Name: Lips, Paul Title: [unknown] Affiliation: Vrije University Medical Center, Amsterdam, The Netherlands --- Article: I. Gerdhem P, Magnusson H, Karlsson MK, Åkesson K. Ultrasound of the phalanges is not related to a previous fracture. A comparison between ultrasound of the phalanges, calcaneus, and DXA of the spine and hip in 75-year-old women. J Clin Densitom 2002; 5(2): 159-66. Article: II. Gerdhem P, Åkesson K, Obrant KJ. Effect of previous and present physical activity on bone mass in elderly women. Osteoporos Int 2003; 14(3): 208-12. Article: III. Gerdhem P, Ringsberg KAM, Åkesson K, Obrant KJ. Influence of muscle strength, physical activity and weight on bone mass in a population-based sample of 1004 elderly women. Osteoporos Int 2003; 14(9): 768-772 Article: IV. Gerdhem P, Ringsberg KAM, Magnusson H, Obrant KJ, Åkesson K. Bone mass cannot be predicted by estimations of frailty in elderly ambulatory women. Gerontology 2003; 49(3): 168-72. Article: V. Gerdhem P, Ringsberg KAM, Åkesson K, Obrant KJ. Just one look and fracture and death can be predicted in elderly ambulant women. Accepted for publication in Gerontology. Article: VI. Gerdhem P, Ivaska KK, Alatalo SL, Halleen JM, Hellman J, Isaksson A, Pettersson K, Väänänen HK, Åkesson K, Obrant KJ. Biochemical markers of bone metabolism and prediction of fracture in elderly women. Accepted for publication in J Bone Miner Res. Article: VII. Gerdhem P, Ringsberg KAM, Fotopoulos M, Obrant KJ, Åkesson K. Association between vitamin D levels, physical activity, muscle strength, falls and fractures in the prospective population-based OPRA study of elderly women. Submitted.