Related Experiment Videos
FRAX predicts incident falls in elderly men: findings from MrOs Sweden
N C Harvey1,2, H Johansson3,4, A Odén3,4
1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
Unlabelled:
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.
Insights
The FRAX tool, used for fracture risk assessment, can predict future falls in elderly men, even outperforming a history of falls over longer follow-up periods.
Area of Science:
- Gerontology
- Osteoporosis Research
- Epidemiology
Background:
- Falls and fractures share common risk factors.
- The FRAX tool, a fracture risk assessment calculator, does not include falls history as an input.
- It is hypothesized that FRAX-incorporated risk factors may also influence falls risk.
Purpose of the Study:
- To determine if FRAX-generated fracture probability predicts incident falls.
- To assess the added value of falls history to FRAX in predicting falls.
- To investigate falls risk in elderly men within the Osteoporotic Fractures in Men (MrOS) Sweden cohort.
Main Methods:
- Prospective cohort study of 1836 elderly men from the MrOS Sweden cohort.
- Collected baseline data including falls history, clinical risk factors, bone mineral density, and FRAX probabilities.
- Incident falls were tracked over an average of 1.8 years using Poisson regression, adjusting for age and time.
Main Results:
- Increased FRAX probabilities at baseline significantly predicted a higher risk of incident falls (HR per SD, 1.16).
- FRAX remained a significant predictor of falls even after adjusting for past falls (HR per SD, 1.12).
- High FRAX scores (>15%) strongly predicted increased falls risk (HR, 1.64), outperforming falls history over extended follow-up.
Conclusions:
- The FRAX tool effectively captures a component of future falls risk, despite falls not being an input variable.
- FRAX demonstrates superior predictive value for falls compared to falls history alone, particularly with longer follow-up durations.
- This suggests FRAX may serve as a valuable tool for identifying individuals at higher risk of falls.