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Risk factors predicting subsequent falls and osteoporotic fractures at 4 years after distal radius fracture—a prospective cohort study

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In a prospective cohort of 113 patients followed 4 years after distal radius fracture (DRF), 24% of patients experienced a subsequent fall and 19% experienced a subsequent fracture. People with poor balance, greater fracture-specific pain/disability, low bone density, and prior falls had nearly a three times higher risk of subsequent falls.


To determine the extent to which modifiable risk factors alone or in combination with bone mineral density (BMD) and non-modifiable risk factors predict subsequent falls and osteoporotic (OP) fractures after distal radius fracture (DRF).


We assessed a cohort of patients (n = 191; mean age = 62 ± 8 years; female = 88%) shortly after DRF (baseline) and again at 4 years to identify subsequent falls or OP fractures. Baseline predictors included age, sex, prior falls, and modifiable risk factors such as balance, muscle strength, physical activity, fear of falling, BMD, fracture-specific pain/disability, and general health status. Univariate, multivariate, and stepwise logistic regression analyses were conducted to compute odds ratio (OR) with 95% CI to determine the extent of association between the risk factors and outcomes.


Among the 113 patients, who completed 4-year follow-up, 24% reported ≥ 1 subsequent fall and 19% reported ≥ 1 subsequent fracture. Significant predictors of subsequent falls included poor balance (OR = 3.3), low total hip BMD (OR = 3.3), high patient-rated wrist evaluation (PRWE) score (OR = 3.0), and prior falls (OR = 3.4). When adjusted for BMD, age, and sex; only prior falls (OR = 4.1) remained a significant independent predictor of future falls. None of the modifiable or non-modifiable risk factors were significantly associated with subsequent fractures.


Prior falls (≥ 2) is an independent predictor of subsequent falls in patients with DRF. In clinical practice, screening of patients for prior falls, balance, fracture-specific pain/disability, and BMD may identify those who might be at risk of subsequent falls after their first DRF.

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Neha Dewan was supported in part by the Joint Motion Program (JuMP): “A Canadian Institute of Health Research (CIHR) Training Program in Musculoskeletal Health Research and Leadership” from University of Western Ontario. Dr. Joy C. MacDermid is supported by a CIHR Chair in Gender, Work and Health and Dr. James Roth Chair in Musculoskeletal Measurement and Knowledge Translation. The research study was funded by CIHR grant award no. 93372. We thank all the patients who volunteered to participate in this study. We would like to thank Prof. Lauren Griffith, for her teachings on logistic regression and Prof. Paul Stratford to review our data analysis. Also, we would like to thank the research assistant Katrina Munro working at Hand and Upper Limb Center, for her kind assistance in accommodating patient appointments for BMD testing scheduled at Hand and Upper Limb Center.

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Correspondence to Neha Dewan, Joy C. MacDermid, Ruby Grewal or Karen Beattie.

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Dewan, N., MacDermid, J.C., Grewal, R. et al. Risk factors predicting subsequent falls and osteoporotic fractures at 4 years after distal radius fracture—a prospective cohort study. Arch Osteoporos 13, 32 (2018).

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