Risk factors for falls within the first 3 months after a fracture.

Abstract

A history of fracture indicates a risk for future fractures. The absolute risk is highest in the first year after a clinical fracture. We investigated the incidence offalls and fracture and the risk factors for falls within 3 months after a fracture. We included 296 consecutive men and women aged 50 years who presented to the hospital with a clinical fracture. Risk factors for falls were assessed according to the guidelines on fall prevention in the Netherlands. Osteoporosis was assessed by measuring bone mineral density (BMO) by OXA in spine and hip regions. Follow-up information on falls and fractures was collected by telephone interview. performed monthly lor 3 months after the primary fracture. Incidence of falls and odds ratio's (OR, with 95% confidence intervals) for falls were calculated. Participants were 288 patients, 209 women (73%) and 79 men (27%). mean age 67 yrs (range: 50-98 yrs). At baseline, no fall risk factors for new falls were present in 15%ofthe patients, I risk factor in 27%. and 2 or more risk factors in 58%. Osteopenia was found in 24% of patients and osteoporosis in 28%. A new fall incident was reported by 40 patients (14%), of whom 5 sutTereda fracture (13% of fallers). Of the 40 fallers, 31 were single fallers and 9 were recurrent fallers (2 falls). The occurrence of falls significantly increased with age (18% in patients between 50 and 60 years. up to 28% in patients aged 80 years; p<0.05) and with the number of fall risk factors (15% in patients without any fall risk at baseline, up to 27% in patients with ;" 2 risk factors, p<0.0 I). More women than men reported a fall (17% vs. 6%, p<0.05). After adjustment for age and gender, low ADL score was the predominant risk factor predicting a new fall (p<O.OI). The incidence offalls was 22% in patients with low AOL, compared to 10% in patients with nonnal AOL. In patients with a normal ADL, urinary incontinence was the predominant risk factor predicting a new fall (p<0.05). In patients with a normal AOL who fell, 23% had urinary incontinence. In 14% of patients a new fall was reported within 3 months after an incident fracture, 13% of those patients sutTereda new fracture. Pre-existent low AOL was the predominant risk factor for new falls. In patients with normal pre-existent AOL, urinary incontinence was the predominant risk factor for new falls.