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The FRAX(tr) algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5years later (range 2.9-8.8years) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04-3.54) and 1.77 (1.16-2.71) in men and women respectively. A history of any fall since the age of 45years resulted in an unadjusted HR of fracture of 7.31 (3.78-14.14) and 8.56 (4.85-15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.

Original publication

DOI

10.1016/j.bone.2012.11.006

Type

Conference paper

Publication Date

02/2013

Volume

52

Pages

541 - 547

Addresses

MRC Lifecourse Epidemiology Unit, (University of Southampton), University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK. me@mrc.soton.ac.uk

Keywords

Femur Neck, Humans, Incidence, Proportional Hazards Models, Risk Factors, ROC Curve, Accidental Falls, Bone Density, Aged, Female, Male, Fractures, Bone, United Kingdom