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

Vandenput, Liesbeth
; 
Johansson, Helena
; 
McCloskey, Eugene V.
; 
Liu, Enwu
; 
Schini, Marian
; 
Åkesson, Kristina E.
; 
Anderson, Fred A.
; 
Azagra, Rafael
; 
Bager, Cecilie L.
; 
Beaudart, Charlotte
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Author
Vandenput, Liesbeth
Johansson, Helena
McCloskey, Eugene V.
Liu, Enwu
Schini, Marian
Åkesson, Kristina E.
Anderson, Fred A.
Azagra, Rafael
Bager, Cecilie L.
Beaudart, Charlotte
Bischoff-Ferrari, Heike A.
Biver, Emmanuel
Bruyère, Olivier
Cauley, Jane A.
Center, Jacqueline R.
Chapurlat, Roland
Christiansen, Claus
Cooper, Cyrus
Crandall, Carolyn J.
Cummings, Steven R.
da Silva, José A. P.
Dawson-Hughes, Bess
Diez-Perez, Adolfo
Dufour, Alyssa B.
Eisman, John A.
Elders, Petra J. M.
Ferrari, Serge
Fujita, Yuki
Fujiwara, Saeko
Glüer, Claus-Christian
Goldshtein, Inbal
Goltzman, David
Gudnason, Vilmundur
Hall, Jill
Hans, Didier
Hoff, Mari
Hollick, Rosemary J.
Huisman, Martijn
Iki, Masayuki
Ish-Shalom, Sophia
Jones, Graeme
Karlsson, Magnus K.
Khosla, Sundeep
Kiel, Douglas P.
Koh, Woon-Puay
Koromani, Fjorda
Kotowicz, Mark A.
Kröger, Heikki
Kwok, Timothy
Lamy, Olivier
Langhammer, Arnulf
Larijani, Bagher
Lippuner, Kurt
McGuigan, Fiona E. A.
Mellström, Dan
Merlijn, Thomas
Nguyen, Tuan V.
Nordström, Anna
Nordström, Peter
O’Neill, Terence W.
Obermayer-Pietsch, Barbara
Ohlsson, Claes
Orwoll, Eric S.
Pasco, Julie A.
Rivadeneira, Fernando
Schott, Anne-Marie
Shiroma, Eric J.
Siggeirsdottir, Kristin
Simonsick, Eleanor M.
Sornay-Rendu, Elisabeth
Sund, Reijo
Swart, Karin M. A.
Szulc, Pawel
Tamaki, Junko
Torgerson, David J.
van Schoor, Natasja M.
van Staa, Tjeerd P.
Vila, Joan
Wareham, Nicholas J.
Wright, Nicole C.
Yoshimura, Noriko
Zillikens, MCarola
Zwart, Marta
Harvey, Nicholas C.
Lorentzon, Mattias
Leslie, William D.
Kanis, John A.
Abstract
Summary The 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. Introduction Previous 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). Methods The 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. Results Falls 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. Conclusions A 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.
Keywords
fracture risk, hip fracture, major osteoporotic fracture, meta-analysis, previous falls, risk factors
Date
2024
Type
Journal article
Journal
Osteoporosis International
Book
Volume
35
Issue
3
Page Range
469-494
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Collections
Mary MacKillop Institute for Health Research
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URI
https://hdl.handle.net/20.500.14802/24125
Relation URI
DOI
10.1007/s00198-023-07012-1
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Open Access Status
License
All rights reserved
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Controlled
Notes
© International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation 2024.