Study Finds Higher Risk for Fracture From Falls in Men Than in Women

BOSTON – A recent study titled “A meta-analysis of previous falls and subsequent fracture risk in cohort studies” found links between self-reported falls and increased fracture risk, and also that prior falls increased risk for fracture slightly more in men than women.

Published in Osteoporosis International, this international meta-analysis of data pooled from 46 prospective cohorts comprising over 900,000 individuals also recommended that previous falls are a factor that should be included in patients’ histories used by fracture risk assessment tools like the FRAX (Fracture Risk Assessment) Tool to calculate a person’s likelihood of getting a fracture over the next decade. FRAX is the most commonly used assessment to predict fracture risk.

“FRAX was developed using longitudinal data from studies around the world. Although previous falls have long been recognized as a significant risk factor for fractures, until now, they have not been factored into the FRAX algorithm,” said Douglas P. Kiel, M.D., MPH, director of the Musculoskeletal Research Center and senior scientist at the Hinda and Arthur Marcus Institute for Aging Research. “In this newly updated FRAX dataset, previous falls were included as a risk factor and were found to increase the risk for fracture. These findings underscore that falls are an important contributor to fracture in both men and women, but interestingly, slightly more in men.”

Key findings of the meta-analysis include:

• Increased Fracture Risk: Individuals with a history of falls within the past year were found to have a significantly higher risk of any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture. One or more previous falls were significantly associated with an increased risk of death among women and men.
• Sex Disparities: The association between previous falls and fracture risk was observed to vary by sex, with men exhibiting higher predictive values compared to women.
• Independent Risk Factor: The increased fracture risk linked to previous falls was largely independent of bone mineral density, emphasizing the standalone significance of falls as a risk factor. A previous fall in the past year confers a significantly increased risk of any clinical fracture, osteoporotic fracture, and hip fracture with the increase in risk varying between 36% and 59% depending on the fracture outcome and sex. 

These findings underscore the importance of incorporating previous falls into the FRAX algorithm,” Dr. Kiel added. Integrating this information into tools like FRAX can enhance their predictive accuracy and ultimately help health care providers to more accurately predict fracture risk and tailor preventive strategies accordingly, to improve patient outcomes.

The lead author was Liesbeth Vandenput, Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. 

Co-authors included:

• Helena Johansson, Mary McKillop Institute for Health Research, Australian Catholic University
• Eugene V. McCloskey, Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
• Enwu Liu, Mary McKillop Institute for Health Research, Australian Catholic University
• Marian Schini, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield
• Kristina E. Åkesson, Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
• Fred A. Anderson, GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA
• Rafael Azagra, Department of Medicine, Autonomous University of Barcelona
• Cecilie L. Bager, Nordic Bioscience A/S, Herlev, Denmark
• Charlotte Beaudart, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
• Heike A. Bischoff‑Ferrari, Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
• Emmanuel Biver, Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
• Olivier Bruyère, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège
• Jane A. Cauley, Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
• Jacqueline R. Center, Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
• Roland Chapurlat, INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
• Claus Christiansen, Nordic Bioscience A/S
• Cyrus Cooper, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
• Carolyn J. Crandall, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
• Steven R. Cummings, San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
• José A. P. da Silva, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
• Bess Dawson‑Hughes, Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston
• Adolfo Diez‑Perez, Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona
• Alyssa B. Dufour, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston  
• John A. Eisman, Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney
• Petra J. M. Elders, Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam
• Serge Ferrari, Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland
• Yuki Fujita, Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka
• Saeko Fujiwara, Department of Pharmacy, Yasuda Women’s University, Hiroshima
• Claus‑Christian Glüer, Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
• Inbal Goldshtein, Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv
• David Goltzman, Department of Medicine, McGill University and McGill University Health Centre, Montreal
• Vilmundur Gudnason, Icelandic Heart Association, Kopavogur, Iceland
• Jill Hall, MRC Centre for Reproductive Health, University of Edinburgh
• Didier Hans, Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital
• Mari Hoff, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
• Rosemary J. Hollick, Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, UK
• Martijn Huisman, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam
• Masayuki Iki, Department of Public Health, Kindai University Faculty of Medicine, Osaka
• Sophia Ish‑Shalom, Endocrine Clinic, Elisha Hospital, Haifa, Israel 
• Graeme Jones; Magnus K. Karlsson, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
• Sundeep Khosla, Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
• Douglas P. Kiel, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston
• Woon‑Puay Koh, Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore
• Fjorda Koromani, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
• Mark A. Kotowicz, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
• Heikki Kröger, Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
• Timothy Kwok, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
• Olivier Lamy, Centre of Bone Diseases, Lausanne University Hospital, Switzerland
• Arnulf Langhammer, HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
• Bagher Larijani, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
• Kurt Lippuner, Department of Osteoporosis, Bern University Hospital, University of Bern, Switzerland
• Fiona E. A. McGuigan, Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
• Dan Mellström; Thomas Merlijn, Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
• Tuan V. Nguyen, School of Medicine Sydney, University of Notre Dame Australia, Sydney
• Anna Nordström, School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
• Peter Nordström, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
• Terence W. O’Neill, National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
• Barbara Obermayer‑Pietsch, Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Austria
• Claes Ohlsson, Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
• Eric S. Orwoll, Department of Medicine, Oregon Health and Science University, Portland, OR
• Julie A. Pasco, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
• Fernando Rivadeneira, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
• Anne‑Marie Schott, Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon
• Eric J. Shiroma, Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD
• Kristin Siggeirsdottir, Icelandic Heart Association, Kopavogur, Iceland
• Eleanor M. Simonsick, Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD
• Elisabeth Sornay‑Rendu, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
• Reijo Sund, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
• Karin M. A. Swart, Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam
• Pawel Szulc, INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
• Junko Tamaki, Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka
• David J. Torgerson, York Trials Unit, Department of Health Sciences, University of York, UK
• Natasja M. van Schoor, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam
• Tjeerd P. van Staa, Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
• Joan Vila, Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona
• Nicholas J. Wareham, MRC Epidemiology Unit, University of Cambridge, UK
• Nicole C. Wright, Department of Epidemiology, University of Alabama at Birmingham, AL
• Noriko Yoshimura, Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo
• M. Carola Zillikens, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
• Marta Zwart, PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona
• Nicholas C. Harvey, MRC Lifecourse Epidemiology Centre, University of Southampton, UK
• Mattias Lorentzon, Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne
• William D. Leslie, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
• John A. Kanis, Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne.

This work was supported by 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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