Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study

Lisanne Vranken; Caroline E Wyers; Robert Y Van der Velde; Heinrich M J Janzing; Sjoerd Kaarsemakers; Johanna Driessen; John Eisman; Jacqueline R Center; Tuan V Nguyen; Thach Tran; Dana Bliuc; Piet Geusens; Joop P van den Bergh

doi:10.1136/bmjopen-2021-058983

Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study

Lisanne Vranken
, Caroline E Wyers
, Robert Y Van der Velde
, Heinrich M J Janzing
, Sjoerd Kaarsemakers
, Johanna Driessen
, John Eisman
, Jacqueline R Center
, Tuan V Nguyen
, Thach Tran
, Dana Bliuc
, Piet Geusens
, Joop P van den Bergh

Maastricht Univeristy Medical Centre
VieCuri Medical Centre
Maastricht University Medical Centre / Maastricht University
Garvan Institute of Medical Research

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVES: To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture.

DESIGN: A 3-year prospective observational cohort study.

SETTING: An outpatient FLS in the Netherlands.

PARTICIPANTS: Patients aged 50+ years with a recent clinical fracture.

OUTCOME MEASURES: Incident falls and subsequent fractures.

RESULTS: The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures.

CONCLUSION: These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care.

TRIAL REGISTRATION NUMBER: NL45707.072.13.

Original language	English
Article number	e058983
Journal	BMJ Open
Volume	12
Issue number	7
DOIs	https://doi.org/10.1136/bmjopen-2021-058983
Publication status	Published - 27 Jul 2022
Externally published	Yes

Keywords

Accidental Falls/statistics & numerical data
Aged
Cohort Studies
Female
Humans
Incidence
Male
Middle Aged
Netherlands/epidemiology
Osteoporosis/complications
Osteoporotic Fractures/epidemiology
Prospective Studies
Risk Factors

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e058983.fullFinal published version, 750 KBLicence: CC BY-NC

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Vranken, L., Wyers, C. E., Van der Velde, R. Y., Janzing, H. M. J., Kaarsemakers, S., Driessen, J., Eisman, J., Center, J. R., Nguyen, T. V., Tran, T., Bliuc, D., Geusens, P., & van den Bergh, J. P. (2022). Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study. BMJ Open, 12(7), Article e058983. https://doi.org/10.1136/bmjopen-2021-058983

@article{304a8cbd914e49ecb801fdea7c8aa808,

title = "Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study",

abstract = "OBJECTIVES: To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture.DESIGN: A 3-year prospective observational cohort study.SETTING: An outpatient FLS in the Netherlands.PARTICIPANTS: Patients aged 50+ years with a recent clinical fracture.OUTCOME MEASURES: Incident falls and subsequent fractures.RESULTS: The study included 488 patients (71.9\% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7\%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9\%). Of the fractures, 47 (78.3\%) were fall related, of which 25 (53.2\%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95\% CI 3.1 to 23.8) increase in the risk of subsequent fractures.CONCLUSION: These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care.TRIAL REGISTRATION NUMBER: NL45707.072.13.",

keywords = "Accidental Falls/statistics \& numerical data, Aged, Cohort Studies, Female, Humans, Incidence, Male, Middle Aged, Netherlands/epidemiology, Osteoporosis/complications, Osteoporotic Fractures/epidemiology, Prospective Studies, Risk Factors",

author = "Lisanne Vranken and Wyers, \{Caroline E\} and \{Van der Velde\}, \{Robert Y\} and Janzing, \{Heinrich M J\} and Sjoerd Kaarsemakers and Johanna Driessen and John Eisman and Center, \{Jacqueline R\} and Nguyen, \{Tuan V\} and Thach Tran and Dana Bliuc and Piet Geusens and \{van den Bergh\}, \{Joop P\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = jul,

day = "27",

doi = "10.1136/bmjopen-2021-058983",

language = "English",

volume = "12",

journal = "BMJ Open",

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Vranken, L, Wyers, CE, Van der Velde, RY, Janzing, HMJ, Kaarsemakers, S, Driessen, J, Eisman, J, Center, JR, Nguyen, TV, Tran, T, Bliuc, D, Geusens, P & van den Bergh, JP 2022, 'Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study', BMJ Open, vol. 12, no. 7, e058983. https://doi.org/10.1136/bmjopen-2021-058983

Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study. / Vranken, Lisanne; Wyers, Caroline E; Van der Velde, Robert Y et al.
In: BMJ Open, Vol. 12, No. 7, e058983, 27.07.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study

AU - Vranken, Lisanne

AU - Wyers, Caroline E

AU - Van der Velde, Robert Y

AU - Janzing, Heinrich M J

AU - Kaarsemakers, Sjoerd

AU - Driessen, Johanna

AU - Eisman, John

AU - Center, Jacqueline R

AU - Nguyen, Tuan V

AU - Tran, Thach

AU - Bliuc, Dana

AU - Geusens, Piet

AU - van den Bergh, Joop P

N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/7/27

Y1 - 2022/7/27

N2 - OBJECTIVES: To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture.DESIGN: A 3-year prospective observational cohort study.SETTING: An outpatient FLS in the Netherlands.PARTICIPANTS: Patients aged 50+ years with a recent clinical fracture.OUTCOME MEASURES: Incident falls and subsequent fractures.RESULTS: The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures.CONCLUSION: These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care.TRIAL REGISTRATION NUMBER: NL45707.072.13.

AB - OBJECTIVES: To evaluate the risk of subsequent fractures in patients who attended the Fracture Liaison Service (FLS), with and without incident falls after the index fracture.DESIGN: A 3-year prospective observational cohort study.SETTING: An outpatient FLS in the Netherlands.PARTICIPANTS: Patients aged 50+ years with a recent clinical fracture.OUTCOME MEASURES: Incident falls and subsequent fractures.RESULTS: The study included 488 patients (71.9% women, mean age: 64.6±8.6 years). During the 3-year follow-up, 959 falls had been ascertained in 296 patients (60.7%) (ie, fallers), and 60 subsequent fractures were ascertained in 53 patients (10.9%). Of the fractures, 47 (78.3%) were fall related, of which 25 (53.2%) were sustained at the first fall incident at a median of 34 weeks. An incident fall was associated with an approximately 9-fold (HR: 8.6, 95% CI 3.1 to 23.8) increase in the risk of subsequent fractures.CONCLUSION: These data suggest that subsequent fractures among patients on treatment prescribed in an FLS setting are common, and that an incident fall is a strong predictor of subsequent fracture risk. Immediate attention for fall risk could be beneficial in an FLS model of care.TRIAL REGISTRATION NUMBER: NL45707.072.13.

KW - Accidental Falls/statistics & numerical data

KW - Aged

KW - Cohort Studies

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Netherlands/epidemiology

KW - Osteoporosis/complications

KW - Osteoporotic Fractures/epidemiology

KW - Prospective Studies

KW - Risk Factors

U2 - 10.1136/bmjopen-2021-058983

DO - 10.1136/bmjopen-2021-058983

M3 - Article

C2 - 35896286

SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

IS - 7

M1 - e058983

ER -

Association between incident falls and subsequent fractures in patients attending the fracture liaison service after an index fracture: a 3-year prospective observational cohort study

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