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)