The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality

• Published in: BMC musculoskeletal disorders Vol. 14; no. 1; p. 121
• Main Authors: Huntjens, Kirsten M B, van Geel, Tineke A C M, van Helden, Svenhjalmar, van den Bergh, Joop, Willems, Paul, Winkens, Bjorn, Geusens, Piet P, Brink, Peter R G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.04.2013; BioMed Central
• Subjects: Accidental Falls - mortality; Accidental Falls - prevention & control; Activities of daily living; Aged; Aged, 80 and over; Bone density; Female; Follow-Up Studies; Fractures; Fractures, Bone - epidemiology; Fractures, Bone - mortality; Fractures, Bone - prevention & control; Humans; Male; Middle Aged; Mortality; Musculoskeletal diseases; Older people; Osteoporosis; Prevention; Prospective Studies; Risk Factors; Time Factors
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/1471-2474-14-121

We analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines. 834 consecutive patients aged ≥50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor). 57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups. Evaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.