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Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year

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Abstract 

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.

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Data availability

The Manitoba Centre for Health Policy does not allow use of primary data outside Manitoba. 

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017- 29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Author information

Authors and Affiliations

  1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    John A. Kanis, Helena Johansson, Mattias Lorentzon, Enwu Liu & Liesbeth Vandenput

  2. Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK

    John A. Kanis, Helena Johansson & Eugene V. McCloskey

  3. MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK

    Nicholas C. Harvey

  4. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Nicholas C. Harvey

  5. Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    Mattias Lorentzon

  6. Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Liesbeth Vandenput

  7. Department of Medicine, McGill University, Montreal, Canada

    Suzanne Morin

  8. University of Manitoba, Winnipeg, Canada

    William D. Leslie

  9. Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK

    Eugene V. McCloskey

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  1. John A. Kanis
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  2. Helena Johansson
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  3. Nicholas C. Harvey
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  4. Mattias Lorentzon
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  5. Enwu Liu
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  6. Liesbeth Vandenput
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  7. Suzanne Morin
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  8. William D. Leslie
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  9. Eugene V. McCloskey
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Corresponding author

Correspondence to John A. Kanis.

Ethics declarations

The study was approved by the Health Research Ethics Board for the University of Manitoba.

Conflicts of interest

W Leslie, E Liu, S Morin, L Vandenput, and H Johansson have no competing interests to declare.

N. Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health, and Internis Pharma.

EV McCloskey has received consultancy/lecture fees/grant funding/honoraria from Amgen, Consilient Healthcare, Fresenius Kabi, Gilead, Internis, Lilly, ObsEva, Radius Health, Redx Oncology, UCB, and I3 Innovus.

JA Kanis is the architect of FRAX.

M Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma, UCB Pharma, and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma, and Consilient Health, all outside the presented work.

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Kanis, J.A., Johansson, H., Harvey, N.C. et al. Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year. Osteoporos Int 34, 479–487 (2023). https://doi.org/10.1007/s00198-022-06633-2

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