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Can fall risk be incorporated into fracture risk assessment algorithms: a pilot study of responsiveness to clodronate

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Abstract

Summary

Fall risk does not significantly impact on the efficacy of the bisphosphonate clodronate in reducing the incidence of fracture.

Introduction

The debate about the efficacy of skeletal therapies on fracture risk in women at increased risk of falling continues. We determined whether fall risk impeded the efficacy of clodronate to reduce osteoporotic fracture incidence.

Methods

This is a post hoc analysis of a 3-year placebo-controlled study of bisphosphonate clodronate involving 5,212 women aged 75 years or more. At entry, self-reported multiple falls in the previous month and ability to rise from a chair were documented. Their interaction with treatment efficacy was examined using Poisson regression.

Results

Oral doses of clodronate at 800 mg daily reduced osteoporotic fracture incidence by 24% (hazard ration (HR) 0.76, 95% confidence interval 0.63–0.93). The efficacy was similar in women with recent multiple falls compared to those without (HR 0.61 vs. 0.77, p value for interaction  >0.30) or impaired ability in rising compared to those with no impairment (HR 0.79 vs. 0.74, respectively; p value > 0.30).

Conclusion

Fall risk does not significantly impact on the anti-fracture efficacy of clodronate. If confirmed with other agents, fall risk may be incorporated into risk assessment tools designed to target skeletal therapies.

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Acknowledgements

We acknowledge the Medical Research Council and Bayer Schering Pharma for funding the original study from which this analysis is derived.

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Authors and Affiliations

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

    K. Kayan, H. Johansson, A. Oden, S. Vasireddy, K. Pande, J. Orgee & J. A. Kanis

  2. Metabolic Bone Centre, Sorby Wing, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    E. V. McCloskey

Authors
  1. K. Kayan
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  2. H. Johansson
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  3. A. Oden
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  4. S. Vasireddy
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  5. K. Pande
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  6. J. Orgee
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  7. J. A. Kanis
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  8. E. V. McCloskey
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Corresponding author

Correspondence to E. V. McCloskey.

Additional information

Study funded by: Bayer Schering Pharma Oy, Helsinki, Finland and Medical Research Council, London, UK

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Kayan, K., Johansson, H., Oden, A. et al. Can fall risk be incorporated into fracture risk assessment algorithms: a pilot study of responsiveness to clodronate. Osteoporos Int 20, 2055–2061 (2009). https://doi.org/10.1007/s00198-009-0942-x

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  • DOI: https://doi.org/10.1007/s00198-009-0942-x

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