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FRAX predicts incident falls in elderly men: findings from MrOs

FRAX predicts incident falls in elderly men: findings from MrOs
FRAX predicts incident falls in elderly men: findings from MrOs
Falls and fractures share several common risk factors. Although past falls is not included as an input variable in the FRAX calculator, we demonstrate that FRAX probability predicts risk of incident falls in the MrOs Sweden cohort.

Introduction

Although not included in the FRAX® algorithm, it is possible that increased falls risk is partly dependent on other risk factors that are incorporated into FRAX. The aim of the present study was to determine whether fracture probability generated by FRAX might also predict risk of incident falls and the extent that a falls history would add value to FRAX.

Methods

We studied the relationship between FRAX probabilities and risk of falls in 1836 elderly men recruited to the MrOS study, a population-based prospective cohort of men from Sweden. Baseline data included falls history, clinical risk factors, bone mineral density (BMD) at femoral neck, and calculated FRAX probabilities. Incident falls were captured during an average of 1.8 years of follow-up. An extension of Poisson regression was used to investigate the relationship between FRAX, other risk variables, and the time-to-event hazard function of falls. All associations were adjusted for age and time since baseline.

Results

At enrolment, 15.5 % of the men had fallen during the preceding 12 months (past falls) and 39 % experienced one or more falls during follow-up (incident falls). The risk of incident falls increased with increasing FRAX probabilities at baseline (hazard ratio (HR) per standard deviation (SD), 1.16; 95 % confidence interval (95%CI), 1.06 to 1.26). The association between incident falls and FRAX probability remained after adjustment for past falls (HR per SD, 1.12; 95%CI, 1.03 to 1.22). High compared with low baseline FRAX score (>15 vs <15 % probability of major osteoporotic fracture) was strongly predictive of increased falls risk (HR, 1.64; 95%CI, 1.36 to 1.97) and remained stable with time. Whereas past falls were a significant predictor of incident falls (HR, 2.75; 95%CI, 2.32 to 3.25), even after adjustment for FRAX, the hazard ratio decreased markedly with increasing follow-up time.

Conclusions

Although falls are not included as an input variable, FRAX captures a component of risk for future falls and outperforms falls history with an extended follow-up time.
epidemiology, falls, fracture, FRAX, osteoporosis
0937-941X
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
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Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Karlsson, M.K.
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Rosengren, B.E.
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Ljunggren, O.
1fcee682-5115-422c-9890-3f33b5dab45c
Cooper, C.
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McCloskey, E.
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Kanis, J.A.
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Ohlsson, C.
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Mellstrom, D.
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Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Karlsson, M.K.
28115dd6-7278-4e26-a577-80a9d2c5a3bb
Rosengren, B.E.
5ece852b-955d-48ca-bc32-75e236d23853
Ljunggren, O.
1fcee682-5115-422c-9890-3f33b5dab45c
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
McCloskey, E.
5211de37-303a-42f8-b24b-00c475264f78
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Ohlsson, C.
6d508551-6ce9-4849-812d-a8fac1db8bfe
Mellstrom, D.
43d24c2f-97e4-423a-acec-6a13b3d477d9

Harvey, N.C., Johansson, H., Oden, A., Karlsson, M.K., Rosengren, B.E., Ljunggren, O., Cooper, C., McCloskey, E., Kanis, J.A., Ohlsson, C. and Mellstrom, D. (2015) FRAX predicts incident falls in elderly men: findings from MrOs. Osteoporosis International. (doi:10.1007/s00198-015-3295-7). (PMID:26391036)

Record type: Article

Abstract

Falls and fractures share several common risk factors. Although past falls is not included as an input variable in the FRAX calculator, we demonstrate that FRAX probability predicts risk of incident falls in the MrOs Sweden cohort.

Introduction

Although not included in the FRAX® algorithm, it is possible that increased falls risk is partly dependent on other risk factors that are incorporated into FRAX. The aim of the present study was to determine whether fracture probability generated by FRAX might also predict risk of incident falls and the extent that a falls history would add value to FRAX.

Methods

We studied the relationship between FRAX probabilities and risk of falls in 1836 elderly men recruited to the MrOS study, a population-based prospective cohort of men from Sweden. Baseline data included falls history, clinical risk factors, bone mineral density (BMD) at femoral neck, and calculated FRAX probabilities. Incident falls were captured during an average of 1.8 years of follow-up. An extension of Poisson regression was used to investigate the relationship between FRAX, other risk variables, and the time-to-event hazard function of falls. All associations were adjusted for age and time since baseline.

Results

At enrolment, 15.5 % of the men had fallen during the preceding 12 months (past falls) and 39 % experienced one or more falls during follow-up (incident falls). The risk of incident falls increased with increasing FRAX probabilities at baseline (hazard ratio (HR) per standard deviation (SD), 1.16; 95 % confidence interval (95%CI), 1.06 to 1.26). The association between incident falls and FRAX probability remained after adjustment for past falls (HR per SD, 1.12; 95%CI, 1.03 to 1.22). High compared with low baseline FRAX score (>15 vs <15 % probability of major osteoporotic fracture) was strongly predictive of increased falls risk (HR, 1.64; 95%CI, 1.36 to 1.97) and remained stable with time. Whereas past falls were a significant predictor of incident falls (HR, 2.75; 95%CI, 2.32 to 3.25), even after adjustment for FRAX, the hazard ratio decreased markedly with increasing follow-up time.

Conclusions

Although falls are not included as an input variable, FRAX captures a component of risk for future falls and outperforms falls history with an extended follow-up time.

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FRAX Predicts Incident Falls in Elderly Men OI 01052015.docx - Accepted Manuscript
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Falls Mr Os Fig 1 05022015.pptx - Other
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More information

e-pub ahead of print date: 21 September 2015
Keywords: epidemiology, falls, fracture, FRAX, osteoporosis
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 382047
URI: http://eprints.soton.ac.uk/id/eprint/382047
ISSN: 0937-941X
PURE UUID: eecc3f04-f3c5-417a-ad03-5f0a14722190
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 22 Oct 2015 13:10
Last modified: 17 Dec 2019 01:56

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Contributors

Author: N.C. Harvey ORCID iD
Author: H. Johansson
Author: A. Oden
Author: M.K. Karlsson
Author: B.E. Rosengren
Author: O. Ljunggren
Author: C. Cooper ORCID iD
Author: E. McCloskey
Author: J.A. Kanis
Author: C. Ohlsson
Author: D. Mellstrom

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