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Falls predict fractures independently of FRAX probability: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study

Falls predict fractures independently of FRAX probability: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study
Falls predict fractures independently of FRAX probability: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study
Although prior falls are a well‐established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow‐up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow‐up time. Random‐effects meta‐analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow‐up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow‐up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow‐up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR = 1.56; 95% CI 1.33, 1.83), and hip fracture (HR = 1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment.
0884-0431
510-516
Harvey, Nicholas C.
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Odén, Anders
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Orwoll, Eric
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Lapidus, Jodi
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Kwok, Timothy
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Karlsson, Magnus
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Rosengren, Bjorn E.
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Ljunggren, Osten
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Cooper, Cyrus
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McCloskey, Eugene
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Kanis, John A.
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Odén, Anders
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Orwoll, Eric
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Lapidus, Jodi
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Kwok, Timothy
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Karlsson, Magnus
85188a16-227b-4a86-a4cc-7b222ca26c5c
Rosengren, Bjorn E.
3434a7e2-291f-44cd-bd8a-7dde0a13b0ab
Ljunggren, Osten
c3230697-b7eb-4918-b484-38b06706efe9
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Ohlsson, Claes
98168752-6ef1-40c6-b873-9361cc99358b
Mellström, Dan
178bfc48-331d-4dec-bda0-45e72d303f6e
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215

Harvey, Nicholas C., Odén, Anders, Orwoll, Eric, Lapidus, Jodi, Kwok, Timothy, Karlsson, Magnus, Rosengren, Bjorn E., Ljunggren, Osten, Cooper, Cyrus, McCloskey, Eugene, Kanis, John A., Ohlsson, Claes, Mellström, Dan and Johansson, Helena (2018) Falls predict fractures independently of FRAX probability: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study. Journal of Bone and Mineral Research, 33 (3), 510-516. (doi:10.1002/jbmr.3331).

Record type: Article

Abstract

Although prior falls are a well‐established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow‐up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow‐up time. Random‐effects meta‐analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow‐up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow‐up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow‐up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR = 1.56; 95% CI 1.33, 1.83), and hip fracture (HR = 1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment.

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nch FRAX MrOs 3 cohorts fall FRAX fracture R2 12_10_2017 final - Accepted Manuscript
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nch FRAX MrOs 3C Fall FRAX Supplementary tables R2 12_10_2017 final
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More information

Accepted/In Press date: 28 October 2017
e-pub ahead of print date: 8 December 2017
Published date: 6 March 2018

Identifiers

Local EPrints ID: 415174
URI: https://eprints.soton.ac.uk/id/eprint/415174
ISSN: 0884-0431
PURE UUID: cce1f59d-f9eb-422d-af8e-a17be4b02da7
ORCID for Nicholas C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 02 Nov 2017 17:30
Last modified: 10 Dec 2019 05:44

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