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A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65 ml/min

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Abstract

Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH)2D3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH)2D3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of <65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ≥65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48–10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/116; OR=3.68; 95% CI, 1.38–9.82; p=0.009). Conclusions: For the first time we showed that in a community-dwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls.

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Acknowledgements

We are indebted to the participants and all our study coworkers; to the team of the laboratory of Rheumatology at the Felix-Platter Spital, Basel, Switzerland; as well as to the team of the Hospital Pharmacy of the Kantonsspital, Basel, Switzerland; to Professor John Orav (Division of Clinical Epidemiology, Brigham and Women’s Hospital, Boston, MA, USA) for statistical consultation and advice; to Dr A. Monsch for advice and encouragement in the preparation of the study protocol and study conduct.

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Authors and Affiliations

  1. Geriatric University Clinic, Kantonsspital, Ambulatorium Wiesendamm, Wiesendamm 22, 4057, Basel, Switzerland

    Laurent C. Dukas

  2. Geriatric University Clinic, Kantonsspital, 4031, Basel, Switzerland

    Hannes B. Stähelin

  3. Metabolic Bone Disease Unit, Universitätsklinik Balgrist, Zurich, Switzerland

    Erich Schacht

  4. Bone Metabolism Unit, TEVA Pharmaceutical Industries, Jerusalem, Israel

    Ze’ev Mazor

Authors
  1. Laurent C. Dukas
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  2. Erich Schacht
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  3. Ze’ev Mazor
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  4. Hannes B. Stähelin
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Corresponding author

Correspondence to Laurent C. Dukas.

Additional information

The study was supported by the following institutions: TEVA Pharmaceuticals Industries, Israel, and University Hospital Basel, Switzerland (scientific grant).

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Dukas, L.C., Schacht, E., Mazor, Z. et al. A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65 ml/min. Osteoporos Int 16, 332–338 (2005). https://doi.org/10.1007/s00198-004-1690-6

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  • DOI: https://doi.org/10.1007/s00198-004-1690-6

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