Abstract
BackgroundPatients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture.MethodsProspective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged ≥ 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals) were calculated.Results512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients.A new fall incident was reported by 42 patients (15%), of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more.Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13–8.06) and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27–4.93).Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 – 5.28). The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 – 8.67).Conclusion15% of patients reported a new fall and 5 patients suffered a new fracture within 3 months. Female sex and low ADL score were the major risk factors and, in addition, polypharmacy in women.
Highlights
Patients with a history of a fracture have an increased risk for future fractures, even in short term
Multivariate analysis in the total group with sex, age, activities of daily living (ADL) difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors
Women had an Odds Ratio (OR) of 3.02 and patients with ADL-difficulties had an OR of 2.50
Summary
Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture. A history of fracture indicates a risk for future fractures. Fall prevention interventions have been shown to reduce certain risk factors for falling, and have successfully reduced falls [2]. No fall prevention intervention study so far has been large enough to determine whether reducing falls will reduce the number of fractures. It is expected that the number of persons who fall and the number of fractures will increase due to the sharp rising in the ageing population. Fractures after menopause and in elderly can have severe consequences in terms of mortality and morbidity, including admission to hospital or to a nursing home and a decrease in quality of life [6,7,9,11]
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