Wheelchair use may lower fracture risk in older patients
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Published results showed older patients who used a wheelchair may have a lower risk for most fractures compared with ambulatory controls.
“Wheelchair use may reduce fracture numbers in old and frail individuals,” Mattias Lorentzon, MD, PhD, professor, senior consultant and head of geriatric medicine at the Institute of Medicine, Sahlgrenska Academy at Sahlgrenska University Hospital in Mölndal, Sweden, told Healio. “In contrast to most current clinical guidelines for osteoporosis management, immobilization due to wheelchair use should not be considered a risk factor for fractures.”
Using a national database of adults 65 years of age or older who underwent a health evaluation at Swedish health care facilities, Lorentzon and colleagues assessed incident fracture, injurious falls without fracture and deaths from Jan. 1, 2007, to Dec. 31, 2017, between 55,442 patients who used wheelchairs and propensity-matched ambulatory controls.
Results showed 7.5% of patients who used a wheelchair and 18.7% of ambulatory controls sustained any fracture during follow-up. Compared with ambulatory controls, researchers found patients who used a wheelchair had a 2.3-fold reduced risk for any fracture, 3.1-fold reduced risk for major osteoporotic fracture and a 3.3-fold reduced risk for hip fracture. Although patients who used a wheelchair had substantially reduced risks for vertebral fracture, proximal humerus fracture and wrist fracture, researchers noted patients who used a wheelchair had a 2.4-fold increased risk for distal femur fracture and a 1.6-fold risk for proximal tibia fracture.
Patients who used wheelchairs also had a lower risk for an injury from a fall compared with ambulatory controls, a difference that remained highly similar after adjustments, according to researchers. However, researchers noted patients who used wheelchairs had a significantly increased risk for death vs. ambulatory controls. When calculated using a Fine and Gray model with death as a competing risk, results showed the association between wheelchair use and fracture outcomes and injurious falls was similar to associations obtained using Cox proportional hazards regression for all fracture outcomes.
“These results provide support for physicians who consider recommending wheelchair use for older frail adults with a high fracture risk,” the authors wrote.
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