John Voytas

Low bone mass and postfall fracture risk among elderly nursing home men.

OBJECTIVE To study postfall fracture risk in relation to bone mineral density. SETTING The study was conducted in men residing in nursing homes. PARTICIPANTS A total of 212 men above the age of 65 years were recruited, and of these, 172 satisfied the inclusion criteria of the study. Among them, 82 were less than 85 years old, and 90 were at least 85 years old. INTERVENTION Bone mineral density (BMD) of the calcaneus was measured, using the Lunar PIXI Bone Densitometer (version 1.43) and charts were reviewed for age, falls, and fractures. MEASUREMENTS The values of BMD were expressed as T-scores, and the Lunar criteria equivalents of T-scores were used (T-scores more than -0.6 for normal BMD, -0.6 to -1.6 for osteopenia, and below -1.6 for osteoporosis). RESULTS The median age of all participants was 84 years (range 65 to 102 years), and their mean T-score at the calcaneus was -1.51. In about 51% of them, the T-score was in the osteoporotic range. For subjects less than 85 years old, the mean T-score was -1.19, and for those 85 years and older, the mean T-score was -1.81; the mean bone density of those in the older old group was significantly lower than those in the younger old group if there was a history of a fracture. Analysis by age quartiles showed a progressive decline in BMD with advancing age. About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture. Among them, 67.6% had osteoporosis. CONCLUSION At any given age after age 65, men who sustained a postfall fracture had a significantly lower BMD than those who did not sustain a postfall fracture.

Do Hemoglobin and Creatinine Clearance Affect Hospital Readmission Rates from a Skilled Nursing Facility Heart Failure Rehabilitation Unit

OBJECTIVES Cardio renal anemia syndrome is being increasingly recognized in patients with congestive heart failure (CHF) and is associated with increased mortality and rehospitalization rates. Our objective was to assess the relationship between hemoglobin (Hb), creatinine clearance (C(Cr)), and hospital readmission in elderly patients enrolled in a skilled nursing facility (SNF)-based CHF rehabilitation unit. METHODS We retrospectively identified 127 consecutive patients admitted to an SNF-based CHF rehabilitation unit between July 2001 and September 2002. The patients were grouped into quintiles of hemoglobin and creatinine clearance (C(Cr)) The rate of hospital readmission between quintiles of above variables was compared using the chi-square test. RESULTS We found a higher prevalence of anemia than reported earlier in the literature for CHF patients discharged from hospital. Rehospitalization rates were increased two- and fivefold in lower compared to higher quintiles of hemoglobin and creatinine clearance, respectively. Anemia predicted rehospitalization in patients with renal dysfunction. CONCLUSION Our study suggests an association between anemia and rehospitalization rates in patients with renal dysfunction enrolled in an SNF-based CHF rehabilitation unit.