Sarah Chiu's presentation from Osteoporosis 2016: Impact of falls on fractures and mortality – an opportunity for intervention and enhancement of fracture prediction? Find out more at: https://nos.org.uk/conference

1. Impact of falls on
fractures and mortality
– an opportunity for intervention
and enhancement of fracture
prediction?
Sarah Chiu, Elizabeth Leneghan,
Lee Shepstone, Fraser Birrell,
Nicholas Harvey, Eugene
McCloskey

2. Conflicts of Interest
• None to declare

3. Risk factors in FRAX…
https://www.shef.ac.uk/FRAX/tool.jsp

4. Risk factors in FRAX…
https://www.shef.ac.uk/FRAX/tool.jsp
Falls
Not currently directly included in FRAX
Other variables in FRAX relate to falls e.g. prior fracture

5. Aim
• To determine if a history of falls predicts
future outcomes independently of FRAX,
including:
– Fractures
– Mortality
• Analysis undertaken using data from the MRC-
and ArthritisResearch UK-funded SCOOP study

6. Letter of invitation
Agree to
take part
CONTROL SCREENING
Intermediate/
High
DXA
Low RiskHigh Risk Unknown
Baseline
Information
Randomisation
Low Risk
• 12 483 women aged 70-85 years,
not on anti-osteoporotic
medication identified from GP
lists
• 7 geographical regions of the UK
• Randomly allocated to control
(usual management) or
intervention (screening).
• In those subjects deemed at high
risk of hip fracture, family doctor
advised to intervene.
• Follow-up for 5 years.
• Osteoporotic fracture as primary
endpoint; hip fracture and
mortality as secondary
endpoints.
Including FRAX questionnaire
FRAX
FRAX

7. At entry, 3444 (27.6%) women reported
one or more falls in the previous year
Table 1: Summary of Baseline Characteristics of Fallers and Non-Fallers
Fallers
(n=3444)
Non-Fallers
(n=8924) p-value
Age (Years) 76±4.28 75.4±4.09 <0.001
BMI 27.05±4.99 26.54±6.29 <0.001
Baseline prevalence (%) of FRAX risk factors
Prior Fracture 1021 (29.6) 1812 (20.3) <0.001
Parental Hip Fracture 348 (10.1) 804 (9.0) 0.007
Current Smoker 152 (4.4) 420 (4.7) 0.489
Alcohol ≥3units/day 141 (4.1) 298 (3.3) 0.049
Glucocorticoid Use 203 (5.9) 421 (4.7) 0.003
Rheumatoid Arthritis 284 (8.2) 538 (6.0) <0.001
Secondary Osteoporosis 979 (28.4) 1879 (21.1) <0.001

8. Fracture and mortality outcomes in
fallers and non-fallers
P<0.001
P<0.001
P<0.001
P<0.001
%
Outcome

9. Relative risk* of outcomes in
fallers
1.32
1.34
1.36
1.36
1.17 1.19
1.22
1.18

10. Relative risk* of outcomes in
fallers
Relative Risk* P-Value
Any Osteoporotic
Fracture 1.18 0.014
Major Osteoporotic
Fracture 1.19 0.017
Death 1.19 0.036

11. • Self-reported history of falls
• Not yet examined impact of single or multiple
falls
• Age range and gender limited
• Large well-characterized community-based
sample
• Excellent capture of incident events (only
verified fractures included)
Limitations and Strengths

12. Non-Fallers Fallers
Fallers were older, had a higher
BMI, and had a higher prevalence
of FRAX variables, apart from
smoking

13. Conclusions
•A history of a fall in the last year is associated with incident
fractures and mortality in women 70-85 years of age in the UK.
•A history of a fall confers a risk that is independent of existing
variables used in FRAX
•Identifying those at highest risk for falls and fractures may
enable targeting of interventions with exercise, nutritional
and/or pharmacological approaches to reduce the burden of
disease and improve healthy ageing.

14. Acknowledgements
• MRC – ArthritisResearch UK
Centre for Integrated
research into
Musculoskeletal Ageing
(CIMA), Department of
Oncology and Metabolism,
University of Sheffield;
ArthritisResearch UK
• Eugene McCloskey (Sheffield)
• Fraser Birrell (Newcastle)