Top

Osteoporosis International

Published in:

Open Access 01-05-2020 | Original Article

A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women

Authors: N. Afrin, R. Sund, R. Honkanen, H. Koivumaa-Honkanen, T. Rikkonen, L. Williams, H. Kröger

Published in: Osteoporosis International | Issue 5/2020

Abstract

Purpose

The purpose of this study was to evaluate if a history of falls predicts future postmenopausal fractures and if this prediction variesaccording to frequency, mechanism, and severity of falls and site of fractures.

Methods

This study used data from OSTPRE prospective cohort. Total study population consisted of 8744 postmenopausal women (mean age 62.2 years) who responded to postal enquiry in 1999 (baseline) and in 2004 (follow-up).

Results

Women were classified by frequency (non/occasional/frequent fallers), mechanism (slip/nonslip), and severity (injurious/ non-injurious) of falls and fractures by site (major osteoporotic/other). A total of 1693 (19.4%) women reported a fall during the preceding 12 months in 1999; 812 a slip fall, 654 a nonslip, 379 an injurious fall, and 1308 a non-injurious fall. A total of 811 women (9.3%) sustained a fracture during the 5-year follow-up period (1999–2004); 431 major osteoporotic fractures and 380 other fractures. Compared with non-fallers, earlier falls predicted subsequent fractures with an OR of 1.41 (95% CI 1.19–1.67, p ≤ 0.001), 1.43 (95% CI 1.14–1.80, p = 0.002) for earlier slip falls, and 1.35 (95% CI 1.04–1.74, p = 0.02) for earlier nonslip falls. Earlier injurious falls predicted future fractures (OR = 1.64, 95% CI 1.21–2.23, p ≤ 0.01), especially other fractures (OR = 1.86, 95% CI 1.24–2.80, p ≤ 0.01), but not major osteoporotic fractures (OR = 1.37, 95% CI 0.89–2.10, p = 0.151). Fracture risk predictions for earlier non-injurious falls was OR = 1.36, 95% CI 1.12–1.64, p = 0.002. These risk patterns remain same after adjustments.

Conclusion

History of falls (especially injurious falls) predicts subsequent fractures (mainly other fractures compared with major osteoporotic fractures) inpostmenopausal women.

Summary

We aimed to investigate if history of falls (frequency, mechanism, and severity) is a predictor of future fractures in postmenopausal women. Our results indicate that history of falls (especially injurious falls) appeared to be an indicator for subsequent fracture overall. Earlier injurious falls were stronger predictors for future other fractures than for typical major osteoporotic fractures.

Available only for authorised users

Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707CrossRef

Kannus P, Niemi S, Palvanen M, Parkkari J (1997) Fall-induced injuries among elderly people. Lancet. 350(9085):1174CrossRef

Baker SP, Harvey AH (1985) Fall injuries in the elderly. Clin Geriatr Med 1(3):501–512CrossRef

Ray NF, Chan JK, Thamer M, Melton LJ III (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the national osteoporosis foundation. J Bone Miner Res 12(1):24–35CrossRef

Schwartz AV, Nevitt MC, Brown BW Jr, Kelsey JL (2005) Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures. Am J Epidemiol 161(2):180–185CrossRef

Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott AM, Hausherr E, Meunier PJ, Bréart G (1996) Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 348(9021):145–149CrossRef

Harvey NC, Odén A, Orwoll E, Lapidus J, Kwok T, Karlsson MK, Rosengren BE, Ljunggren Ö, Cooper C, McCloskey E, Kanis JA, Ohlsson C, Mellström D, Johansson H (2018) Falls predict fractures independently of FRAX probability: a meta-analysis of the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 33(3):510–516CrossRef

Van Staa T, Geusens P, Kanis J, Leufkens H, Gehlbach S, Cooper C (2006) A simple clinical score for estimating the long-term risk of fracture in post-menopausal women. J Assoc Phys 99(10):673–682

Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR (1992) Study of osteoporotic fractures research group. Risk factors for fractures of the distal forearm and proximal humerus. Am J Epidemiol 135(5):477–489CrossRef

10.

Honkanen R (1982) The role of slippery weather in accidental falls. J Occup Accid 4(2–4):257–262CrossRef

11.

Tromp A, Smit J, Deeg D, Bouter L, Lips P (1998) Predictors for falls and fractures in the longitudinal aging study Amsterdam. J Bone Miner Res 13(12):1932–1939CrossRef

12.

Ensrud KE, Ewing SK, Taylor BC et al (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol Ser A Biol Med Sci 62(7):744–751CrossRef

13.

Cumming RG, Klineberg RJ (1994) Fall frequency and characteristics and the risk of hip fractures. J Am Geriatr Soc 42(7):774–778CrossRef

14.

Afrin N, Honkanen R, Koivumaa-Honkanen H, Lukkala P, Rikkonen T, Sirola J, Williams LJ, Kröger H (2016) Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women. Maturitas. 91:19–24CrossRef

15.

Afrin N, Honkanen R, Koivumaa-Honkanen H et al (2018) Role of musculoskeletal disorders in falls of postmenopausal women. Osteoporos Int 29(11):2419–2426CrossRef

16.

Nevitt MC, Cummings SR, Hudes ES (1991) Risk factors for injurious falls: a prospective study. J Gerontol 46(5):M164–M170CrossRef

17.

Kanis JA, Odén A, Johansson H, McCloskey EV (2013) Fracture risk assessment: the development and application of FRAX®. In: Marcus R, Feldman D, Dempster DW, Luckey M, Cauley JA (ed.) Osteoporosis (fourth edition). Elsevier, pp. 1611–1637

18.

Center JR (2013) Outcomes following osteoporotic fractures. In: Marcus R, Feldman D, Dempster DW, Luckey M, Cauley JA (ed.) Osteoporosis (fourth edition). Elsevier, pp. 841–852

19.

Randell K, Honkanen R, Kröger H, Saarikoski S (2002) Does hormone-replacement therapy prevent fractures in early postmenopausal women? J Bone Miner Res 17:528–533CrossRef

20.

Tinetti ME, Speechley M (1989) Prevention of falls among the elderly. N Engl J Med 320(16):1055–1059CrossRef

21.

Bath PA, Morgan K (1999) Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK. Eur J Epidemiol 15(1):65–73CrossRef

22.

Luukinen H, Herala M, Koski K, Honkanen R, Laippala P, Kivelä S (2000) Fracture risk associated with a fall according to type of fall among the elderly. Osteoporos Int 11(7):631–634CrossRef

23.

Tuppurainen M, Härmä K, Komulainen M, Kiviniemi V, Kröger H, Honkanen R, Alhava E, Jurvelin J, Saarikoski S (2010) Effects of continuous combined hormone replacement therapy and clodronate on bone mineral density in osteoporotic postmenopausal women: a 5-year follow-up. Maturitas. 66(4):423–430CrossRef

24.

Randell KM, Honkanen RJ, Komulainen MH, Tuppurainen MT, Kröger H, Saarikoski S (2001) Hormone replacement therapy and risk of falling in early postmenopausal women–a population-based study. Clin Endocrinol 54(6):769–774CrossRef

25.

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767CrossRef

26.

Nguyen TV, Center JR, Sambrook PN, Eisman JA (2001) Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women the Dubbo osteoporosis epidemiology study. Am J Epidemiol 153(6):587–595CrossRef

27.

Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH (2002) Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc 50(1):97–103CrossRef

28.

Edwards M, Jameson K, Denison H, Harvey NC, Sayer AA, Dennison EM, Cooper C (2013) Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women. Bone. 52(2):541–547CrossRef

29.

Cummings SR, Nevitt MC, Kidd S (1988) Forgetting falls. J Am Geriatr Soc 36(7):613–616CrossRef

30.

Honkanen K, Honkanen R, Heikkinen L, Kröger H, Saarikoski S (1999) Validity of self-reports of fractures in perimenopausal women. Am J Epidemiol 150(5):511–516CrossRef

Title: A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women
Authors: N. Afrin
R. Sund
R. Honkanen
H. Koivumaa-Honkanen
T. Rikkonen
L. Williams
H. Kröger
Publication date: 01-05-2020
Publisher: Springer London
Published in: Osteoporosis International / Issue 5/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-05255-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women

Abstract

Purpose

Methods

Results

Conclusion

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Summary

Please log in to get access to this content

Other articles of this Issue 5/2020

Analysis of mortality after hip fracture on patient, hospital, and regional level in Germany

Risk for hip fracture before and after total knee replacement in Sweden

Intravenous bisphosphonate therapy in children with spinal muscular atrophy

Postmenopausal women with osteoporosis consume high amounts of vegetables but insufficient dairy products and calcium to benefit from their virtues: the CoLaus/OsteoLaus cohort

Comparison of multimedia and printed patient education tools for patients with osteoporosis: a 6-month randomized controlled trial

Incidental bilateral calcaneal fractures following overground walking with a wearable robotic exoskeleton in a wheelchair user with a chronic spinal cord injury: is zero risk possible?