fracture risk; hip fracture; major osteoporotic fracture; meta-analysis; previous falls; risk factors; Male; Humans; Female; Prospective Studies; Risk Assessment; Cohort Studies; Risk Factors; Bone Density; Osteoporotic Fractures/epidemiology; Osteoporotic Fractures/etiology; Hip Fractures/etiology; Hip Fractures/complications; Hip Fractures; Osteoporotic Fractures; Endocrinology, Diabetes and Metabolism
Abstract :
[en] [en] UNLABELLED: 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.
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).
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.
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.
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.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Vandenput, Liesbeth ; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
Johansson, Helena; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK ; Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
McCloskey, Eugene V ; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK ; MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
Liu, Enwu; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
Schini, Marian; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
Åkesson, Kristina E; Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden ; Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
Anderson, Fred A; GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
Azagra, Rafael; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain ; Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain ; GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Barcelona, Spain ; PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain
Beaudart, Charlotte ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie générale ; Department of Health Services Research, University of Maastricht, Maastricht, The Netherlands
Bischoff-Ferrari, Heike A; Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland ; Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
Biver, Emmanuel; Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Cauley, Jane A; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Center, Jacqueline R; Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia ; St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia ; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
Chapurlat, Roland; INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
Cooper, Cyrus ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK ; NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
Crandall, Carolyn J; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Cummings, Steven R; San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
da Silva, José A P; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal ; Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
Dawson-Hughes, Bess; Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
Diez-Perez, Adolfo; Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
Dufour, Alyssa B; Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA ; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
Eisman, John A; Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia ; St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia ; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
Elders, Petra J M; Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Ferrari, Serge; Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Fujita, Yuki; Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
Fujiwara, Saeko; Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
Glüer, Claus-Christian; Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
Goldshtein, Inbal; Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel ; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Goltzman, David; Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
Gudnason, Vilmundur; Icelandic Heart Association, Kopavogur, Iceland ; University of Iceland, Reykjavik, Iceland
Hall, Jill; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
Hans, Didier; Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
Hoff, Mari; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
Hollick, Rosemary J; Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
Huisman, Martijn; Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands ; Department of Sociology, VU University, Amsterdam, The Netherlands
Iki, Masayuki; Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
Ish-Shalom, Sophia; Endocrine Clinic, Elisha Hospital, Haifa, Israel
Jones, Graeme; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
Karlsson, Magnus K; Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden ; Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
Khosla, Sundeep; Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
Kiel, Douglas P; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
Koh, Woon-Puay; Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
Koromani, Fjorda; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands ; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
Kotowicz, Mark A; IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia ; Barwon Health, Geelong, VIC, Australia ; Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
Kröger, Heikki; Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland ; Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
Kwok, Timothy; Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong ; Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Lamy, Olivier; Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland ; Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
Langhammer, Arnulf; HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
Larijani, Bagher; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
Lippuner, Kurt; Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
McGuigan, Fiona E A; Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
Mellström, Dan; Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
Merlijn, Thomas; Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Nguyen, Tuan V; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia ; School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia ; School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
Nordström, Anna; School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway ; Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden ; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
Nordström, Peter; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
O'Neill, Terence W; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK ; Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
Obermayer-Pietsch, Barbara; Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria ; Center for Biomarker Research in Medicine, Graz, Austria
Ohlsson, Claes; Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
Orwoll, Eric S; Department of Medicine, Oregon Health and Science University, Portland, OR, USA
Pasco, Julie A; IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia ; Barwon Health, Geelong, VIC, Australia ; Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia ; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Rivadeneira, Fernando; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
Schott, Anne-Marie; Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
Shiroma, Eric J; Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
Simonsick, Eleanor M; Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
Sornay-Rendu, Elisabeth; INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
Sund, Reijo; Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
Swart, Karin M A; Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ; PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
Szulc, Pawel; INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
Tamaki, Junko; Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
Torgerson, David J; York Trials Unit, Department of Health Sciences, University of York, York, UK
van Schoor, Natasja M; Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
van Staa, Tjeerd P; Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
Vila, Joan; Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
Wareham, Nicholas J; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
Wright, Nicole C; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
Yoshimura, Noriko; Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
Zillikens, MCarola; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
Zwart, Marta; PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain ; Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain ; Department of Medical Sciences, University of Girona, Girona, Spain ; GROIMAP/GROICAP (Research Groups), Unitat de Suport a La Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
Harvey, Nicholas C; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
Lorentzon, Mattias; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ; Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
Leslie, William D; Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
Kanis, John A ; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@sheffield.ac.uk ; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.Pontefract@sheffield.ac.uk
NC Harvey acknowledges funding from the UK Medical Research Council (MC_PC_21003; MC_PC_21001). The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005. Funding for the MrOS USA study comes from the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. Funding for the SOF study comes from the National Institute on Aging (NIA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), supported by grants (AG05407, AR35582, AG05394, AR35584, and AR35583). Funding for the Health ABC study was from the Intramural research program at the National Institute on Aging under the following contract numbers: NO1-AG-6–2101, NO1-AG-6–2103, and NO1-AG-6–2106.
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