Abstract
BackgroundWe analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines.Methods834 consecutive patients aged ≥50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor).Results57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups.ConclusionEvaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.
Highlights
We analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines
Patients with a combination of bone- and fall-related risk factors versus all other patients Univariable Cox analysis showed that patients with a combination of risk factors had a significantly higher subsequent fracture risk than all other patients (HR: 1.99, 95% Confidence Interval (CI): 1.18-3.36 p=0.010) (Figure 3)
Patients with a combination of risk factors compared to group 4 No significant differences were found between the groups on subsequent fracture risk within 2-years after univariable (HR 1.61; 95% CI: 0.77-3.38) and multivariable cox regression analyses (HR 1.16; 95% CI: 0.53-2.55)
Summary
We analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines. For persons above fifty years of age, a history of fracture doubles the risk of a subsequent fracture [1]. In patients with a recent fracture, other bone-related clinical risk factors, low bone mineral density (BMD) and fall-related risk factors are often present [7]. These risk factors are independently related to fracture risk and are used in algorithms to calculate fracture risk, like FRAXW [8] and Garvan Fracture Risk calculator [9]. Fall prevention strategies decrease the risk of falls, in these studies prevention of fractures was not demonstrated [18]
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