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

Authors :
Vandenput L
Johansson H
McCloskey EV
Liu E
Schini M
Åkesson KE
Anderson FA
Azagra R
Bager CL
Beaudart C
Bischoff-Ferrari HA
Biver E
Bruyère O
Cauley JA
Center JR
Chapurlat R
Christiansen C
Cooper C
Crandall CJ
Cummings SR
da Silva JAP
Dawson-Hughes B
Diez-Perez A
Dufour AB
Eisman JA
Elders PJM
Ferrari S
Fujita Y
Fujiwara S
Glüer CC
Goldshtein I
Goltzman D
Gudnason V
Hall J
Hans D
Hoff M
Hollick RJ
Huisman M
Iki M
Ish-Shalom S
Jones G
Karlsson MK
Khosla S
Kiel DP
Koh WP
Koromani F
Kotowicz MA
Kröger H
Kwok T
Lamy O
Langhammer A
Larijani B
Lippuner K
McGuigan FEA
Mellström D
Merlijn T
Nguyen TV
Nordström A
Nordström P
O'Neill TW
Obermayer-Pietsch B
Ohlsson C
Orwoll ES
Pasco JA
Rivadeneira F
Schott AM
Shiroma EJ
Siggeirsdottir K
Simonsick EM
Sornay-Rendu E
Sund R
Swart KMA
Szulc P
Tamaki J
Torgerson DJ
van Schoor NM
van Staa TP
Vila J
Wareham NJ
Wright NC
Yoshimura N
Zillikens M
Zwart M
Harvey NC
Lorentzon M
Leslie WD
Kanis JA
Source :
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2024 Mar; Vol. 35 (3), pp. 469-494. Date of Electronic Publication: 2024 Jan 17.
Publication Year :
2024

Abstract

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.<br />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).<br />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.<br />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.<br />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.<br /> (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Details

Language :
English
ISSN :
1433-2965
Volume :
35
Issue :
3
Database :
MEDLINE
Journal :
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Publication Type :
Academic Journal
Accession number :
38228807
Full Text :
https://doi.org/10.1007/s00198-023-07012-1