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Fracture prediction from self-reported falls in routine clinical practice: a registry-based cohort study

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Abstract

Summary

A simple question construct regarding number of falls in the previous year, ascertained by a single question, was strongly associated with incident fractures in routine clinical practice using a population-based dual-energy X-ray absorptiometry (DXA) registry.

Introduction

There is conflicting evidence from research cohorts that falls independently increase fracture risk. We examined the independent effects of falls on subsequent fractures in a large clinical registry of bone mineral density (BMD) results for the Province of Manitoba, Canada that has been systematically collecting self-reported falls information since September 1, 2012.

Methods

The study population consisted of 24,943 women and men aged 40 years and older (mean age 65.5 ± 10.2 years) with fracture probability assessment (FRAX), self-reported falls for the previous year (categorized as none, 1, 2, or > 3) and fracture outcomes. Adjusted hazard ratios (HR) with 95 confidence intervals (CI) for time to fracture were estimated using Cox proportional hazards models.

Results

During mean observation time of 2.7 ± 1.0 years, 863 (3.5%) sustained one or more major osteoporotic fractures (MOF), 212 (0.8%) sustained a hip fracture, and 1210 (4.9%) sustained any incident fracture. Compared with no falls in the previous year (referent), there was a gradient of increasing risk for fracture with increasing number of falls (all P < 0.001). Results showed minimal attenuation with covariate adjustment. When adjusted for baseline fracture probability (FRAX score with BMD) the HR for MOF increased from 1.49 (95% CI 1.25–1.78) for one fall to 1.74 (1.33–2.27) for two falls to 2.62 (2.06–3.34) for ≥ 3 falls. HRs were similar for any incident fracture and slightly greater for prediction of hip fracture, reaching 3.41 (95% CI 2.19–5.31) for ≥ 3 previous falls.

Conclusions

Self-report number of falls in the previous year is strongly associated with incident fracture risk in the routine clinical practice setting, and this risk is independent of age, sex, BMD, and baseline fracture probability. Moreover, there is dose–response with multiple falls (up to a maximum of 3) conferring greater risk than a single fall.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). SNM is chercheur-boursier des Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair.

Author information

Authors and Affiliations

  1. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    W.D. Leslie, L.M. Lix, P. Martineau & M. Bryanton

  2. McGill University, Montreal, Canada

    S.N. Morin

  3. Harvard Medical School, Boston, MA, USA

    P. Martineau

  4. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

    E.V. McCloskey, H. Johansson & J.A. Kanis

  5. Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia

    H. Johansson & J.A. Kanis

  6. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    N.C. Harvey

  7. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N.C. Harvey

Authors
  1. W.D. Leslie
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  2. S.N. Morin
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  3. L.M. Lix
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  4. P. Martineau
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  5. M. Bryanton
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  6. E.V. McCloskey
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  7. H. Johansson
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  9. J.A. Kanis
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Corresponding author

Correspondence to W.D. Leslie.

Ethics declarations

The study was approved by the Health Research Ethics Board for the University of Manitoba.

Conflicts of interest

Suzanne Morin: Nothing to declare for the context of this paper, but has received research grants from Amgen, Merck.

Eugene McCloskey: Nothing to declare for the context of this paper, but numerous ad hoc consultancies/speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi-Aventis, Servier, Tethys, UBS, and Warner Chilcott.

Nicholas Harvey: Nothing to declare for the context of this paper, but has received consultancy/ lecture fees/honoraria/ grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare, and Internis Pharma.

John A. Kanis: Grants from Amgen, Lilly, Radius Health and non-financial support from Medimaps outside the submitted work.

William Leslie, Patrick Martineau, Mark Bryanton, Lisa Lix, Helena Johansson: No conflicts of interest.

Disclaimer

The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

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Leslie, W., Morin, S., Lix, L. et al. Fracture prediction from self-reported falls in routine clinical practice: a registry-based cohort study. Osteoporos Int 30, 2195–2203 (2019). https://doi.org/10.1007/s00198-019-05106-3

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