Summary

A greater propensity to falling is associated with higher fracture risk. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior falls.

Introduction

Prior falls increase subsequent fracture risk but are not currently directly included in the FRAX tool. The aim of this study was to quantify the effect of the number of prior falls on the 10-year probability of fracture determined with FRAX®.

Methods

We studied 21,116 women and men age 40 years or older (mean age 65.7 ± 10.1 years) with fracture probability assessment (FRAX®), self-reported falls for the previous year, and subsequent fracture outcomes in a registry-based cohort. The risks of death, hip fracture, and non-hip major osteoporotic fracture (MOF-NH) were determined by Cox proportional hazards regression for fall number category versus the whole population (i.e., an average number of falls). Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of falls from the hazards of death and fracture incorporated into the FRAX model for the UK. The probability ratios (number of falls vs. average number of falls) provided adjustments to conventional FRAX estimates of fracture probability according to the number of falls.

Results

Compared with the average number of falls, the hazard ratios for hip fracture, MOF-NH and death were lower than unity in the absence of a fall history. Hazard ratios increased progressively with an increasing number of reported falls. The probability ratio rose progressively as the number of reported falls increased. Probability ratios decreased with age, an effect that was more marked the greater the number of prior falls.

Conclusion

The probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior falls.

中文翻译：

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根据前一年跌倒次数调整传统的 FRAX 骨折概率估计值

概括

跌倒倾向越大，骨折风险越高。本研究对基于 FRAX 的骨折概率进行了调整，考虑了先前跌倒的次数。

介绍

既往跌倒会增加后续骨折风险，但目前并未直接包含在 FRAX 工具中。本研究的目的是量化先前跌倒次数对使用 FRAX® 确定的 10 年骨折概率的影响。

方法

我们研究了 21,116 名年龄在 40 岁或以上（平均年龄 65.7 ± 10.1 岁）的女性和男性，他们在基于登记的队列中进行了骨折概率评估 (FRAX®)、自我报告的前一年跌倒情况以及随后的骨折结果。死亡、髋部骨折和非髋部主要骨质疏松性骨折 (MOF-NH) 的风险由跌倒次数类别与整个人群（即平均跌倒次数）的 Cox 比例风险回归确定。髋部骨折和主要骨质疏松性骨折 (MOF) 的十年概率是根据纳入英国 FRAX 模型的死亡和骨折危险跌倒次数确定的。概率比（跌倒次数与平均跌倒次数）根据跌倒次数对传统 FRAX 骨折概率估计进行了调整。

结果

与平均跌倒次数相比，在没有跌倒史的情况下，髋部骨折、MOF-NH 和死亡的风险比低于统一值。随着报告跌倒次数的增加，风险比逐渐增加。随着报告跌倒次数的增加，概率比逐渐上升。概率比随着年龄的增长而下降，这种影响在之前跌倒的次数越多时越明显。

结论

概率比根据先前跌倒的次数对传统的 FRAX 骨折概率估计值进行调整。