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.

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.
Competing Interests: Competing interests: LV, CEW, RYVdV, HMJJ, SK, JD, JE, TT and DB have nothing to disclose. JRC reports honoraria for educational talks and part support for educational meetings from Amgen, and advisory board participation for Amgen and Bayer, outside the submitted work. TVN reports honoraria for lectures sponsored from Merck and participation as executive member Asia Pacific Consortium on Osteoporosis, outside the submitted work. PG reports grants from Amgen, Pfizer, MSD, UCB, Abbott, Lilly, BMS, Novartis, Roche and Will Pharma, and honoraria for lectures from Amgen and Lilly, outside the submitted work. JPvdB reports grants for lectures from UCB and Amgen, outside the submitted work.
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