A meta-analysis of previous falls and subsequent fracture risk in cohort studies

Liesbeth Vandenput; Helena Johansson; Eugene V. McCloskey; Enwu Liu; Marian Schini; Kristina E. Åkesson; Fred A. Anderson; Rafael Azagra; Cecilie L. Bager; Charlotte Beaudart; Heike A. Bischoff-Ferrari; Emmanuel Biver; Olivier Bruyère; Jane A. Cauley; Jacqueline R. Center; Roland Chapurlat; Claus Christiansen; Cyrus Cooper; Carolyn J. Crandall; Steven R. Cummings; José A. P. da Silva; Bess Dawson-Hughes; Adolfo Diez-Perez; Alyssa B. Dufour; John A. Eisman; Petra J. M. Elders; Serge Ferrari; Yuki Fujita; Saeko Fujiwara; Claus-Christian Glüer; Inbal Goldshtein; David Goltzman; Vilmundur Gudnason; Jill Hall; Didier Hans; Mari Hoff; Rosemary J. Hollick; Martijn Huisman; Masayuki Iki; Sophia Ish-Shalom; Graeme Jones; Magnus K. Karlsson; Sundeep Khosla; Douglas P. Kiel; Woon-Puay Koh; Fjorda Koromani; Mark A. Kotowicz; Heikki Kröger; Timothy Kwok; Olivier Lamy; Arnulf Langhammer; Bagher Larijani; Kurt Lippuner; Fiona E. A. McGuigan; Dan Mellström; Thomas Merlijn; Tuan V. Nguyen; Anna Nordström; Peter Nordström; Terence W. O’Neill; Barbara Obermayer-Pietsch; Claes Ohlsson; Eric S. Orwoll; Julie A. Pasco; Fernando Rivadeneira; Anne-Marie Schott; Eric J. Shiroma; Kristin Siggeirsdottir; Eleanor M. Simonsick; Elisabeth Sornay-Rendu; Reijo Sund; Karin M. A. Swart; Pawel Szulc; Junko Tamaki; David J. Torgerson; Natasja M. van Schoor; Tjeerd P. van Staa; Joan Vila; Nicholas J. Wareham; Nicole C. Wright; Noriko Yoshimura; M. Carola Zillikens; Marta Zwart; Nicholas C. Harvey; Mattias Lorentzon; William D. Leslie; John A. Kanis

doi:10.1007/s00198-023-07012-1

A meta-analysis of previous falls and subsequent fracture risk in cohort studies

Liesbeth Vandenput, Helena Johansson, Eugene V. McCloskey, Enwu Liu, Marian Schini, Kristina E. Åkesson, Fred A. Anderson, Rafael Azagra, Cecilie L. Bager, Charlotte Beaudart, Heike A. Bischoff-Ferrari, Emmanuel Biver, Olivier Bruyère, Jane A. Cauley, Jacqueline R. Center, Roland Chapurlat, Claus Christiansen, Cyrus Cooper, Carolyn J. Crandall, Steven R. CummingsJosé A. P. da Silva, Bess Dawson-Hughes, Adolfo Diez-Perez, Alyssa B. Dufour, John A. Eisman, Petra J. M. Elders, Serge Ferrari, Yuki Fujita, Saeko Fujiwara, Claus-Christian Glüer, Inbal Goldshtein, David Goltzman, Vilmundur Gudnason, Jill Hall, Didier Hans, Mari Hoff, Rosemary J. Hollick, Martijn Huisman, Masayuki Iki, Sophia Ish-Shalom, Graeme Jones, Magnus K. Karlsson, Sundeep Khosla, Douglas P. Kiel, Woon-Puay Koh, Fjorda Koromani, Mark A. Kotowicz, Heikki Kröger, Timothy Kwok, Olivier Lamy, Arnulf Langhammer, Bagher Larijani, Kurt Lippuner, Fiona E. A. McGuigan, Dan Mellström, Thomas Merlijn, Tuan V. Nguyen, Anna Nordström, Peter Nordström, Terence W. O’Neill, Barbara Obermayer-Pietsch, Claes Ohlsson, Eric S. Orwoll, Julie A. Pasco, Fernando Rivadeneira, Anne-Marie Schott, Eric J. Shiroma, Kristin Siggeirsdottir, Eleanor M. Simonsick, Elisabeth Sornay-Rendu, Reijo Sund, Karin M. A. Swart, Pawel Szulc, Junko Tamaki, David J. Torgerson, Natasja M. van Schoor, Tjeerd P. van Staa, Joan Vila, Nicholas J. Wareham, Nicole C. Wright, Noriko Yoshimura, M. Carola Zillikens, Marta Zwart, Nicholas C. Harvey, Mattias Lorentzon, William D. Leslie, John A. Kanis

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	469-494
Number of pages	26
Journal	Osteoporosis international
Volume	35
Issue number	3
Early online date	2024
DOIs	https://doi.org/10.1007/s00198-023-07012-1
Publication status	Published - Mar 2024

Keywords

fracture risk
hip fracture
major osteoporotic fracture
meta-analysis
previous falls
risk factors

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10.1007/s00198-023-07012-1

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Vandenput, L., Johansson, H., McCloskey, E. V., Liu, E., Schini, M., Åkesson, K. E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., Crandall, C. J., ... Kanis, J. A. (2024). A meta-analysis of previous falls and subsequent fracture risk in cohort studies. Osteoporosis international, 35(3), 469-494. https://doi.org/10.1007/s00198-023-07012-1

@article{e0f2891681e64494a067bbec961a3803,

title = "A meta-analysis of previous falls and subsequent fracture risk in cohort studies",

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{\textregistered} 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.",

keywords = "fracture risk, hip fracture, major osteoporotic fracture, meta-analysis, previous falls, risk factors",

author = "Liesbeth Vandenput and Helena Johansson and McCloskey, {Eugene V.} and Enwu Liu and Marian Schini and {\AA}kesson, {Kristina E.} and Anderson, {Fred A.} and Rafael Azagra and Bager, {Cecilie L.} and Charlotte Beaudart and Bischoff-Ferrari, {Heike A.} and Emmanuel Biver and Olivier Bruy{\`e}re and Cauley, {Jane A.} and Center, {Jacqueline R.} and Roland Chapurlat and Claus Christiansen and Cyrus Cooper and Crandall, {Carolyn J.} and Cummings, {Steven R.} and {da Silva}, {Jos{\'e} A. P.} and Bess Dawson-Hughes and Adolfo Diez-Perez and Dufour, {Alyssa B.} and Eisman, {John A.} and Elders, {Petra J. M.} and Serge Ferrari and Yuki Fujita and Saeko Fujiwara and Claus-Christian Gl{\"u}er and Inbal Goldshtein and David Goltzman and Vilmundur Gudnason and Jill Hall and Didier Hans and Mari Hoff and Hollick, {Rosemary J.} and Martijn Huisman and Masayuki Iki and Sophia Ish-Shalom and Graeme Jones and Karlsson, {Magnus K.} and Sundeep Khosla and Kiel, {Douglas P.} and Woon-Puay Koh and Fjorda Koromani and Kotowicz, {Mark A.} and Heikki Kr{\"o}ger and Timothy Kwok and Olivier Lamy and Arnulf Langhammer and Bagher Larijani and Kurt Lippuner and McGuigan, {Fiona E. A.} and Dan Mellstr{\"o}m and Thomas Merlijn and Nguyen, {Tuan V.} and Anna Nordstr{\"o}m and Peter Nordstr{\"o}m and O{\textquoteright}Neill, {Terence W.} and Barbara Obermayer-Pietsch and Claes Ohlsson and Orwoll, {Eric S.} and Pasco, {Julie A.} and Fernando Rivadeneira and Anne-Marie Schott and Shiroma, {Eric J.} and Kristin Siggeirsdottir and Simonsick, {Eleanor M.} and Elisabeth Sornay-Rendu and Reijo Sund and Swart, {Karin M. A.} and Pawel Szulc and Junko Tamaki and Torgerson, {David J.} and {van Schoor}, {Natasja M.} and {van Staa}, {Tjeerd P.} and Joan Vila and Wareham, {Nicholas J.} and Wright, {Nicole C.} and Noriko Yoshimura and Zillikens, {M. Carola} and Marta Zwart and Harvey, {Nicholas C.} and Mattias Lorentzon and Leslie, {William D.} and Kanis, {John A.}",

note = "Publisher Copyright: {\textcopyright} International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation 2024.",

year = "2024",

month = mar,

doi = "10.1007/s00198-023-07012-1",

language = "English",

volume = "35",

pages = "469--494",

journal = "Osteoporosis international",

issn = "0937-941X",

publisher = "Springer London",

number = "3",

}

Vandenput, L, Johansson, H, McCloskey, EV, Liu, E, Schini, M, Åkesson, KE, Anderson, FA, Azagra, R, Bager, CL, Beaudart, C, Bischoff-Ferrari, HA, Biver, E, Bruyère, O, Cauley, JA, Center, JR, Chapurlat, R, Christiansen, C, Cooper, C, Crandall, CJ, Cummings, SR, da Silva, JAP, Dawson-Hughes, B, Diez-Perez, A, Dufour, AB, Eisman, JA, Elders, PJM, Ferrari, S, Fujita, Y, Fujiwara, S, Glüer, C-C, Goldshtein, I, Goltzman, D, Gudnason, V, Hall, J, Hans, D, Hoff, M, Hollick, RJ, Huisman, M, Iki, M, Ish-Shalom, S, Jones, G, Karlsson, MK, Khosla, S, Kiel, DP, Koh, W-P, Koromani, F, Kotowicz, MA, Kröger, H, Kwok, T, Lamy, O, Langhammer, A, Larijani, B, Lippuner, K, McGuigan, FEA, Mellström, D, Merlijn, T, Nguyen, TV, Nordström, A, Nordström, P, O’Neill, TW, Obermayer-Pietsch, B, Ohlsson, C, Orwoll, ES, Pasco, JA, Rivadeneira, F, Schott, A-M, Shiroma, EJ, Siggeirsdottir, K, Simonsick, EM, Sornay-Rendu, E, Sund, R, Swart, KMA, Szulc, P, Tamaki, J, Torgerson, DJ, van Schoor, NM, van Staa, TP, Vila, J, Wareham, NJ, Wright, NC, Yoshimura, N, Zillikens, MC, Zwart, M, Harvey, NC, Lorentzon, M, Leslie, WD & Kanis, JA 2024, 'A meta-analysis of previous falls and subsequent fracture risk in cohort studies', Osteoporosis international, vol. 35, no. 3, pp. 469-494. https://doi.org/10.1007/s00198-023-07012-1

TY - JOUR

T1 - A meta-analysis of previous falls and subsequent fracture risk in cohort studies

AU - Vandenput, Liesbeth

AU - Johansson, Helena

AU - McCloskey, Eugene V.

AU - Liu, Enwu

AU - Schini, Marian

AU - Åkesson, Kristina E.

AU - Anderson, Fred A.

AU - Azagra, Rafael

AU - Bager, Cecilie L.

AU - Beaudart, Charlotte

AU - Bischoff-Ferrari, Heike A.

AU - Biver, Emmanuel

AU - Bruyère, Olivier

AU - Cauley, Jane A.

AU - Center, Jacqueline R.

AU - Chapurlat, Roland

AU - Christiansen, Claus

AU - Cooper, Cyrus

AU - Crandall, Carolyn J.

AU - Cummings, Steven R.

AU - da Silva, José A. P.

AU - Dawson-Hughes, Bess

AU - Diez-Perez, Adolfo

AU - Dufour, Alyssa B.

AU - Eisman, John A.

AU - Elders, Petra J. M.

AU - Ferrari, Serge

AU - Fujita, Yuki

AU - Fujiwara, Saeko

AU - Glüer, Claus-Christian

AU - Goldshtein, Inbal

AU - Goltzman, David

AU - Gudnason, Vilmundur

AU - Hall, Jill

AU - Hans, Didier

AU - Hoff, Mari

AU - Hollick, Rosemary J.

AU - Huisman, Martijn

AU - Iki, Masayuki

AU - Ish-Shalom, Sophia

AU - Jones, Graeme

AU - Karlsson, Magnus K.

AU - Khosla, Sundeep

AU - Kiel, Douglas P.

AU - Koh, Woon-Puay

AU - Koromani, Fjorda

AU - Kotowicz, Mark A.

AU - Kröger, Heikki

AU - Kwok, Timothy

AU - Lamy, Olivier

AU - Langhammer, Arnulf

AU - Larijani, Bagher

AU - Lippuner, Kurt

AU - McGuigan, Fiona E. A.

AU - Mellström, Dan

AU - Merlijn, Thomas

AU - Nguyen, Tuan V.

AU - Nordström, Anna

AU - Nordström, Peter

AU - O’Neill, Terence W.

AU - Obermayer-Pietsch, Barbara

AU - Ohlsson, Claes

AU - Orwoll, Eric S.

AU - Pasco, Julie A.

AU - Rivadeneira, Fernando

AU - Schott, Anne-Marie

AU - Shiroma, Eric J.

AU - Siggeirsdottir, Kristin

AU - Simonsick, Eleanor M.

AU - Sornay-Rendu, Elisabeth

AU - Sund, Reijo

AU - Swart, Karin M. A.

AU - Szulc, Pawel

AU - Tamaki, Junko

AU - Torgerson, David J.

AU - van Schoor, Natasja M.

AU - van Staa, Tjeerd P.

AU - Vila, Joan

AU - Wareham, Nicholas J.

AU - Wright, Nicole C.

AU - Yoshimura, Noriko

AU - Zillikens, M. Carola

AU - Zwart, Marta

AU - Harvey, Nicholas C.

AU - Lorentzon, Mattias

AU - Leslie, William D.

AU - Kanis, John A.

PY - 2024/3

Y1 - 2024/3

N2 - 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.

AB - 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.

KW - fracture risk

KW - hip fracture

KW - major osteoporotic fracture

KW - meta-analysis

KW - previous falls

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=85182464977&partnerID=8YFLogxK

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85182464977&origin=inward

U2 - 10.1007/s00198-023-07012-1

DO - 10.1007/s00198-023-07012-1

M3 - Article

C2 - 38228807

SN - 0937-941X

VL - 35

SP - 469

EP - 494

JO - Osteoporosis international

JF - Osteoporosis international

IS - 3

ER -

A meta-analysis of previous falls and subsequent fracture risk in cohort studies

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