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Results From the Progetto Veneto Anziani Study

Maria-Chiara Corti, MD, MHS; Giovannella Baggio, MD; Leonardo Sartori, MD; Gianmaria Barbato, MD; Enzo Manzato, MD; Estella Musacchio, PhD; Luigi Ferrucci, MD, PhD; Giulia Cardinali, PhD; Daniele Donato, MD; Lenore J. Launer, PhD; Sabina Zambon, MD; Gaetano Crepaldi, MD; Jack M. Guralnik, MD, PhD

Arch Intern Med. 2007;167(16):1745-1751.

Background  White matter lesions (WMLs) are associated with hypertension, an increased risk of falling, and impaired physical and cognitive performance that may affect the mechanical effect of falls.

Methods  We hypothesized that WMLs are a risk factor for hip fracture (HF). We studied a sample of 820 community-dwelling Italian persons 65 years and older from the cohort of the Progetto Veneto Anziani Study who underwent brain magnetic resonance imaging at baseline. Subjects were classified as having no lesions, focal lesions, or diffuse WMLs.

Results  Compared with those with no lesions, participants with diffuse WMLs were older, reported more falls, and had worse physical and cognitive performance, all factors implicated in the causal pathway to HF. During 9 years of follow-up, 51 HFs occurred. Hip fracture risk associated with diffuse WMLs markedly differed between participants younger than 80 years vs those 80 years and older. After adjustment among participants younger than 80 years, diffuse WMLs compared with no lesions were associated with a 2.7-fold (95% confidence interval, 1.1-7.1) increase in the risk of HF. Focal lesions were not statistically significantly associated with an increased risk of HF in the same age group (hazard ratio, 2.0; 95% confidence interval, 0.6-7.6). No associations between diffuse WMLs, focal lesions, and HF were evident among participants 80 years and older, possibly because of the limited sample size.

Conclusions  White matter lesions represent an independent risk factor for HF in persons younger than 80 years. Older persons with diffuse WMLs should be considered candidates for multifactorial interventions aimed at reducing the risk of falling and fractures.

Author Affiliations: Azienda Unità Locale Socio Sanitaria (ULSS)16-Padova (Drs Corti and Donato), Azienda Ospedaliera (Drs Baggio, Barbato, and Zambon), Department of Medical and Surgical Sciences, School of Medicine, University of Padova (Drs Sartori and Musacchio), and Aging Section, Consiglio Nazionale delle Ricerche (CNR) Institute of Neurosciences (Drs Manzato and Crepaldi), Padova, and Azienda ULSS12-Venezia (Dr Cardinali), Italy; and Baltimore Longitudinal Study of Aging, Gerontology Research Center, National Institute on Aging, Baltimore (Dr Ferrucci), and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda (Drs Launer and Guralnik), Maryland.