A meta-analysis of previous falls and subsequent fracture risk in cohort studies

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Vandenput, LiesbethAustralian Catholic Univ, Mary McKillop Inst Hlth Res, Melbourne, Vic, Australia.,Australian Catholic University (author)

A meta-analysis of previous falls and subsequent fracture risk in cohort studies

Article/chapterEnglish2024

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Springer,2024
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LIBRIS-ID:oai:DiVA.org:uu-533514
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-533514URI
https://doi.org/10.1007/s00198-023-07012-1DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-50299URI
https://gup.ub.gu.se/publication/334362URI
https://lup.lub.lu.se/record/8339f7a6-a301-4806-ada7-2fcf28536d07URI

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Summary in:English

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SummaryThe relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm.IntroductionPrevious falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD).MethodsThe resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients.ResultsFalls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33–1.51) and men (HR 1.53, 95% CI 1.41–1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27–1.84) in men vs. HR 1.32 (95% CI 1.20–1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men.ConclusionsA previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Ortopedi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Orthopaedics hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
fracture risk
hip fracture
major osteoporotic fracture
meta-analysis
previous falls
risk factors
fracture risk
hip fracture
major osteoporotic fracture
meta-analysis
previous falls
risk factors

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Åkesson, K.E.Lund University,Lunds universitet,Medicinska fakulteten,Ortopedi - klinisk och molekylär osteoporosforskning,Forskargrupper vid Lunds universitet,Faculty of Medicine,Orthopedics - Clinical and Molecular Osteoporosis Research,Lund University Research Groups,Lund Univ, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Lund, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmö, Sweden.(Swepub:lu)orto-kak (author)
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Australian Catholic Univ, Mary McKillop Inst Hlth Res, Melbourne, Vic, Australia.Australian Catholic University (creator_code:org_t)

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