Fracture risk - Overview

Factors increasing fracture risk in elderly people in residential care facilities

Assess home type and balance grade

The patient's housing status is an indicator of their functional status. Nursing home patients generally have a lower functional status, increasing their fracture risk.

A consideration of housing status in combination with the patient's ability to balance provides is a better indicator of fracture risk. Determine the patient's balance grading as follows:

Balance grading

Grade 1 Unable to stand on the floor for any period without support from another person or use of a walking aid.
Grade 2 Unable to maintain balance on the floor for 30 seconds.
Grade 3 Capable of maintaining balance on the floor for 30 s but unable to maintain balance on a compliant foam rubber mat(70 × 60 × 15 cm thick) for any period of time.
Grade 4 Capable of maintaining balance on the floor but unable to maintain balance on the foam rubber mat for 30 seconds.
Grade 5 Capable of maintaining balance when standing on the floor and on the foam mat for 30 seconds.

Determine whether the patient has had a previous fracture

Patients who have had a previous fracture are at a substantially increased risk of future fractures.

Cognitively assess the patient

Perform a cognitive assessment using the Mini-Mental State Examination. Patients whose MMSE score ranges between 18-23 out of 30 have a higher fracture risk.

Determine the number of medications taken by the patient

Increased numbers of regular medications increases the risk for potential medication interactions and adverse outcomes in older patients.

Determine the patient's body weight

Low body weight in older patients is an indication of frailty with increased risk of fractures.

Determine length of the patient's lower leg

A lower leg length of more than 50.5cm is associated with an increased risk of fracture in elderly patients.