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A Meta-Analysis of Previous Falls and Subsequent Fracture Risk in Cohort Studies Publisher Pubmed



Vandenput L1 ; Johansson H1, 2, 3 ; Mccloskey EV2, 4 ; Liu E1 ; Schini M5 ; Akesson KE6, 7 ; Anderson FA8 ; Azagra R9, 10, 11, 12 ; Bager CL13 ; Beaudart C14, 15 ; Bischoffferrari HA16, 17 ; Biver E18 ; Bruyere O14 ; Cauley JA19 Show All Authors
Authors
  1. Vandenput L1
  2. Johansson H1, 2, 3
  3. Mccloskey EV2, 4
  4. Liu E1
  5. Schini M5
  6. Akesson KE6, 7
  7. Anderson FA8
  8. Azagra R9, 10, 11, 12
  9. Bager CL13
  10. Beaudart C14, 15
  11. Bischoffferrari HA16, 17
  12. Biver E18
  13. Bruyere O14
  14. Cauley JA19
  15. Center JR20, 21, 22
  16. Chapurlat R23
  17. Christiansen C13
  18. Cooper C24, 25, 26
  19. Crandall CJ27
  20. Cummings SR28
  21. Da Silva JAP29, 30
  22. Dawsonhughes B31
  23. Diezperez A32
  24. Dufour AB33, 34
  25. Eisman JA20, 21, 22
  26. Elders PJM35
  27. Ferrari S18
  28. Fujita Y36
  29. Fujiwara S37
  30. Gluer CC38
  31. Goldshtein I39, 40
  32. Goltzman D41
  33. Gudnason V42, 43
  34. Hall J44
  35. Hans D45
  36. Hoff M46, 47
  37. Hollick RJ48
  38. Huisman M49, 50
  39. Iki M51
  40. Ishshalom S52
  41. Jones G53
  42. Karlsson MK6, 54
  43. Khosla S55
  44. Kiel DP33, 34
  45. Koh WP56, 57
  46. Koromani F58, 59
  47. Kotowicz MA60, 61, 62
  48. Kroger H63, 64
  49. Kwok T65, 66
  50. Lamy O67, 68
  51. Langhammer A69
  52. Larijani B70
  53. Lippuner K71
  54. Mcguigan FEA6
  55. Mellstrom D72, 73
  56. Merlijn T35
  57. Nguyen TV22, 74, 75
  58. Nordstrom A76, 77, 78
  59. Nordstrom P79
  60. Oneill TW80, 81
  61. Obermayerpietsch B82, 83
  62. Ohlsson C3, 84
  63. Orwoll ES85
  64. Pasco JA60, 61, 62, 86
  65. Rivadeneira F58
  66. Schott AM87
  67. Shiroma EJ88
  68. Siggeirsdottir K42, 89
  69. Simonsick EM90
  70. Sornayrendu E23
  71. Sund R64
  72. Swart KMA91, 92
  73. Szulc P23
  74. Tamaki J93
  75. Torgerson DJ94
  76. Van Schoor NM49
  77. Van Staa TP95
  78. Vila J96
  79. Wareham NJ97
  80. Wright NC98
  81. Yoshimura N99
  82. Zillikens M58
  83. Zwart M12, 100, 101, 102
  84. Harvey NC24, 25
  85. Lorentzon M1, 3, 103
  86. Leslie WD104
  87. Kanis JA1, 2
Show Affiliations
Authors Affiliations
  1. 1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
  2. 2. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
  3. 3. Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  4. 4. MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, United Kingdom
  5. 5. Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
  6. 6. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
  7. 7. Department of Orthopedics, Skane University Hospital, Malmo, Sweden
  8. 8. GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States
  9. 9. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
  10. 10. Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
  11. 11. GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Cerdanyola del Valles, Barcelona, Spain
  12. 12. PRECIOSA-Fundacion Para La Investigacion, Barbera del Valles, Barcelona, Spain
  13. 13. Nordic Bioscience A/S, Herlev, Denmark
  14. 14. WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
  15. 15. Department of Health Services Research, University of Maastricht, Maastricht, Netherlands
  16. 16. Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
  17. 17. Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
  18. 18. Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
  19. 19. Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
  20. 20. Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
  21. 21. St Vincent’s Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
  22. 22. School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
  23. 23. INSERM UMR 1033, Universite Claude Bernard-Lyon1, Hopital Edouard Herriot, Lyon, France
  24. 24. MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
  25. 25. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
  26. 26. NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, United Kingdom
  27. 27. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
  28. 28. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States
  29. 29. Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  30. 30. Rheumatology Department, Centro Hospitalar E Universitario de Coimbra, Coimbra, Portugal
  31. 31. Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, United States
  32. 32. Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
  33. 33. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
  34. 34. Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
  35. 35. Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  36. 36. Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
  37. 37. Department of Pharmacy, Yasuda Women’s University, Hiroshima, Japan
  38. 38. Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
  39. 39. Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
  40. 40. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  41. 41. Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
  42. 42. Icelandic Heart Association, Kopavogur, Iceland
  43. 43. University of Iceland, Reykjavik, Iceland
  44. 44. MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
  45. 45. Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
  46. 46. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
  47. 47. Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
  48. 48. Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
  49. 49. Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
  50. 50. Department of Sociology, VU University, Amsterdam, Netherlands
  51. 51. Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
  52. 52. Endocrine Clinic, Elisha Hospital, Haifa, Israel
  53. 53. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
  54. 54. Department of Orthopaedics, Skane University Hospital, Malmo, Sweden
  55. 55. Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States
  56. 56. Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  57. 57. Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
  58. 58. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
  59. 59. Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
  60. 60. IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
  61. 61. Barwon Health, Geelong, VIC, Australia
  62. 62. Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
  63. 63. Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
  64. 64. Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
  65. 65. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  66. 66. Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
  67. 67. Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
  68. 68. Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
  69. 69. HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
  70. 70. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  71. 71. Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
  72. 72. Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  73. 73. Geriatric Medicine, Sahlgrenska University Hospital Molndal, Molndal, Sweden
  74. 74. School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
  75. 75. School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
  76. 76. School of Sport Sciences, UiT The Arctic University of Norway, Tromso, Norway
  77. 77. Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Ostersund, Sweden
  78. 78. Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  79. 79. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
  80. 80. National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
  81. 81. Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
  82. 82. Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
  83. 83. Center for Biomarker Research in Medicine, Graz, Austria
  84. 84. Department of Drug Treatment, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden
  85. 85. Department of Medicine, Oregon Health and Science University, Portland, OR, United States
  86. 86. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  87. 87. Universite Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
  88. 88. Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, United States
  89. 89. Janus Rehabilitation, Reykjavik, Iceland
  90. 90. Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, United States
  91. 91. Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
  92. 92. PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
  93. 93. Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
  94. 94. York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
  95. 95. Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
  96. 96. Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  97. 97. MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
  98. 98. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
  99. 99. Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
  100. 100. Health Center Can Gibert del Pla, Catalan Institute of Health, Girona, Spain
  101. 101. Department of Medical Sciences, University of Girona, Girona, Spain
  102. 102. GROIMAP/GROICAP (Research Groups), Unitat de Suport a La Recerca Girona, Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Girona, Spain
  103. 103. Region Vastra Gotaland, Geriatric Medicine, Sahlgrenska University Hospital, Molndal, Sweden
  104. 104. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada

Source: Osteoporosis International Published:2024


Abstract

Summary: 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. © International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation 2024.