Fracture Prediction: Ask About Falls

Researchers from the UK are providing further evidence that clinicians should speak up and ask about a patient’s history of falls. Such information, says the team from the University of Southampton, is valuable in determining someone’s future risk of fracture.

Not all methods of assessing fracture risk include questions on previous falls; one that does is the FRAX model.

The team, led by Dr. Mark Edwards, Clinical Research Fellow at the MRC Lifecourse Epidemiology Unit at the University of Southampton, has shown that when knowledge of fall history is used the clinician’s ability to predict whether an individual will break a bone is further improved.

Dr. Edwards commented in the November 23, 2012 news release: “In a clinical setting, asking whether a patient has fallen is quick and easy. Nearly 60% of all hospital admissions due to fractures in England are the result of a fall. Fracture prediction is extremely important to allow us to target treatments to those at greatest risk: assessing falls history provides us a further tool with which to do so.”

During the study the participants’ risk factors, including age, sex, height, weight, family history, smoking, alcohol, rheumatoid arthritis, and whether they had a previous fracture or fall, were assessed along with bone density. At follow up each individual was asked whether they had suffered a new fracture.

The investigators found that using risk factors, similar to those in the FRAX model, showed a good level of fracture prediction. Adding bone density further improved accuracy. However, when fall history was also added in, the model was augmented further especially in men in whom predictive capacity increased by 6%. Furthermore, in over 80% of men that had not fallen and did not subsequently fracture, the addition of this variable to the model correctly reduced their predicted fracture risk.

Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit at the University of Southampton, added: “This research illustrates the importance of well-characterised population cohorts such as the Hertfordshire Cohort Study to clinical decision making. The enhanced fracture risk prediction facilitated through use of our findings will help reduce the ever-growing burden of fractures in the elderly.”