Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study
Piet Geusens,
Jacqueline R Center,
Tuan V Nguyen,
Thach Tran,
Johanna Driessen,
Joop P van den Bergh,
John Eisman,
Caroline E Wyers,
Lisanne Vranken,
Robert Y Van der Velde,
Heinrich M J Janzing,
Sjoerd Kaarsemakers,
Dana Bliuc
Affiliations
Piet Geusens
1Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium
Jacqueline R Center
Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
Tuan V Nguyen
Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
Thach Tran
Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
Johanna Driessen
Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
Joop P van den Bergh
Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
John Eisman
School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
Caroline E Wyers
Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
Lisanne Vranken
Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
Robert Y Van der Velde
Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
Heinrich M J Janzing
Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
Sjoerd Kaarsemakers
Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, The Netherlands
Dana Bliuc
Department of Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
Objectives To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture.Design A 3-year prospective observational cohort study.Setting An outpatient FLS in the Netherlands.Participants Patients aged 50+ years with a recent clinical fracture.Outcome measures Incident falls and subsequent fractures.Results The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures.Conclusion These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care.Trial registration number NL45707.072.13.
