Abstract
ABSTRACTAlthough prior falls are a well‐established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow‐up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow‐up time. Random‐effects meta‐analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow‐up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow‐up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow‐up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR = 1.56; 95% CI 1.33, 1.83), and hip fracture (HR = 1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
Highlights
Low bone mineral density is a major risk factor for fragility fracture, the majority of such low-trauma fracture events occur as a result of a fall from standing height or less.[1]
Having demonstrated that the risk of future falls associated with past falls is partly captured by FRAX,(11) we undertook to investigate, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether a history of past falls independently predicted future fractures and whether the predictive value varied with follow-up time or age
No interactions for either follow-up time or age with high FRAX probability were observed. In this large combined population cohort of older men, we have demonstrated that previous falls and high FRAX probability independently predict the risk of future fracture
Summary
Low bone mineral density is a major risk factor for fragility fracture, the majority of such low-trauma fracture events occur as a result of a fall from standing height or less.[1]. Notwithstanding, prior falls have been found to be a risk factor for future fracture in a number of cohorts.[4] With the advent of the FRAX fracture risk assessment tool, evaluation of an individual’s probability of sustaining a hip or major osteoporotic fracture over a 10-year time period is readily undertaken using a small number of ascertainable clinical risk factors and BMD if available.[5] FRAX is the most widely used fracture risk assessment tool, incorporated into the majority of assessment guidelines worldwide[6] but, unlike other tools such as QFracture or the GARVAN calculator,(7–9) does not include falls as a specific input risk factor[4,5] because of the inconsistent data across the 12 derivation and 11 validation cohorts.[10] In order for prior falls to be useful in the current context of risk assessment, the associated fracture risk must ideally be independent of FRAX probability and/or BMD. Having demonstrated that the risk of future falls associated with past falls is partly captured by FRAX,(11) we undertook to investigate, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether a history of past falls (in the previous 12 months) independently predicted future fractures and whether the predictive value varied with follow-up time or age
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