Impact of falls on fractures and mortality
– an opportunity for intervention and enhancement of fracture
prediction?Sarah Chiu, Elizabeth Leneghan,
Lee Shepstone, Fraser Birrell, Nicholas Harvey, Eugene
McCloskey
Conflicts of Interest
• None to declare
Risk factors in FRAX…
https://www.shef.ac.uk/FRAX/tool.jsp
Risk factors in FRAX…
https://www.shef.ac.uk/FRAX/tool.jsp
Falls Not currently directly included in FRAX Other variables in FRAX relate to falls e.g. prior fracture
Aim
• To determine if a history of falls predicts future outcomes independently of FRAX, including:– Fractures– Mortality
• Analysis undertaken using data from the MRC- and ArthritisResearch UK-funded SCOOP study
Letter of invitation
Agree to take part
CONTROL SCREENING
Intermediate/High
DXA
Low RiskHigh Risk Unknown
Baseline Information
Randomisation
Low Risk
• 12 483 women aged 70-85 years, not on anti-osteoporotic medication identified from GP lists
• 7 geographical regions of the UK
• Randomly allocated to control (usual management) or intervention (screening).
• In those subjects deemed at high risk of hip fracture, family doctor advised to intervene.
• Follow-up for 5 years.
• Osteoporotic fracture as primary endpoint; hip fracture and mortality as secondary endpoints.
Including FRAX questionnaire
FRAX
FRAX
At entry, 3444 (27.6%) women reported one or more falls in the previous year
Table 1: Summary of Baseline Characteristics of Fallers and Non-Fallers
Fallers (n=3444)
Non-Fallers (n=8924) p-value
Age (Years) 76±4.28 75.4±4.09 <0.001
BMI 27.05±4.99 26.54±6.29 <0.001
Baseline prevalence (%) of FRAX risk factors
Prior Fracture 1021 (29.6) 1812 (20.3) <0.001
Parental Hip Fracture 348 (10.1) 804 (9.0) 0.007
Current Smoker 152 (4.4) 420 (4.7) 0.489
Alcohol ≥3units/day 141 (4.1) 298 (3.3) 0.049
Glucocorticoid Use 203 (5.9) 421 (4.7) 0.003
Rheumatoid Arthritis 284 (8.2) 538 (6.0) <0.001
Secondary Osteoporosis 979 (28.4) 1879 (21.1) <0.001
Fracture and mortality outcomes in fallers and non-fallers
P<0.001
P<0.001
P<0.001
P<0.001%
Outcome
Relative risk* of outcomes in fallers
1.32 1.34
1.361.36
1.17 1.19
1.22 1.18
Relative risk* of outcomes in fallers
Relative Risk* P-ValueAny Osteoporotic
Fracture 1.18 0.014
Major Osteoporotic Fracture 1.19 0.017
Death 1.19 0.036
• Self-reported history of falls• Not yet examined impact of single or multiple
falls• Age range and gender limited
• Large well-characterized community-based sample
• Excellent capture of incident events (only verified fractures included)
Limitations and Strengths
Non-Fallers Fallers
Fallers were older, had a higher BMI, and had a higher prevalence
of FRAX variables, apart from smoking
Conclusions
•A history of a fall in the last year is associated with incident fractures and mortality in women 70-85 years of age in the UK.
•A history of a fall confers a risk that is independent of existing variables used in FRAX
•Identifying those at highest risk for falls and fractures may enable targeting of interventions with exercise, nutritional and/or pharmacological approaches to reduce the burden of disease and improve healthy ageing.
Acknowledgements
• MRC – ArthritisResearch UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, University of Sheffield; ArthritisResearch UK
• Eugene McCloskey (Sheffield) • Fraser Birrell (Newcastle)
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