Fractures in older people - incidence, predictors and consequences

In older populations, fractures are common and the consequences of fractures may be serious both for an individual and for society. However, information is scarce about the incidence, predictors and consequences of fractures in population-based unselected cohorts including both men and women and a long follow-up. The objective of this study was to analyse the incidence and predictors of fractures as well as functional decline and excess mortality due to fractures, among 482 men and 695 women aged 65 or older in the municipality of Lieto, Finland from 1991 until 2002. In analyses, Poisson’s, Cox proportional Hazards and Cumulative Logistic regression models were used for the control of several confounding variables. During the 12-year follow-up with a total of 10 040 person-years (PY), 307 (26%) persons sustained altogether 425 fractures of which 77% were sustained by women. The total incidence of fractures was 53.4 per 1000 PY (95% confidence intervals [95% CI]: 47.9 - 59.5) in women and 24.9 per 1000 PY (95% CI: 20.4 - 30.4) in men. The incidence rates of fractures at any sites and hip fractures were associated with increasing age. No significant changes in the ageadjusted incidence rates of fractures were found in either gender during the 12-year follow-up. The predictors of fractures varied by gender. In multivariate analyses, reduced handgrip strength and body mass index (BMI) lower than 30 in women and a large number of depressive symptoms in men were independent predictors of fractures. A compression fracture in one or more thoracic or upper lumbar vertebras on chest radiography at baseline was associated with subsequent fractures in both genders. Lower body fractures independently predicted both short- (0-2 years) and long-term (up to 8 years) functional decline in mobility and activities of daily living (ADL) performance during the 8-year follow-up. Upper body fractures predicted decline in ADL performance during longterm follow-up. In the 12-year follow-up, hip fractures in men (Hazard Ratio [HR] 8.1, 95% CI: 4.4-14.9) and in women (HR 3.0, 95% CI: 1.9-4.9), and fractures at the proximal humerus in men (HR 5.4, 95% CI: 1.6-17.7) were independently associated with excess mortality. In addition, leisure time inactivity in physical exercise predicted independently both functional decline and excess mortality. Fractures are common among older people posing serious individual consequences. Further studies about the effectiveness of preventing falls and fractures as well as improving care and rehabilitation after fractures are needed.

Development of finite elements for analysis of biomechanical structures using flexible multibody formulations

The absolute nodal coordinate formulation was originally developed for the analysis of structures undergoing large rotations and deformations. This dissertation proposes several enhancements to the absolute nodal coordinate formulation based finite beam and plate elements. The main scientific contribution of this thesis relies on the development of elements based on the absolute nodal coordinate formulation that do not suffer from commonly known numerical locking phenomena. These elements can be used in the future in a number of practical applications, for example, analysis of biomechanical soft tissues. This study presents several higher-order Euler–Bernoulli beam elements, a simple method to alleviate Poisson’s and transverse shear locking in gradient deficient plate elements, and a nearly locking free gradient deficient plate element. The absolute nodal coordinate formulation based gradient deficient plate elements developed in this dissertation describe most of the common numerical locking phenomena encountered in the formulation of a continuum mechanics based description of elastic energy. Thus, with these fairly straightforwardly formulated elements that are comprised only of the position and transverse direction gradient degrees of freedom, the pathologies and remedies for the numerical locking phenomena are presented in a clear and understandable manner. The analysis of the Euler–Bernoulli beam elements developed in this study show that the choice of higher gradient degrees of freedom as nodal degrees of freedom leads to a smoother strain field. This improves the rate of convergence.