Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands.
NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Age Ageing. 2023 Oct 2;52(10). doi: 10.1093/ageing/afad201.
Adults with a recent fracture have a high imminent risk of a subsequent fracture. We hypothesise that, like subsequent fracture risk, fall risk is also highest immediately after a fracture. This study aims to assess if fall risk is time-dependent in subjects with a recent fracture compared to subjects without a fracture.
This retrospective matched cohort study used data from the UK Clinical Practice Research Datalink GOLD. All subjects ≥50 years with a fracture between 1993 and 2015 were identified and matched one-to-one to fracture-free controls based on year of birth, sex and practice. The cumulative incidence and relative risk (RR) of a first fall was calculated at various time intervals, with mortality as competing risk. Subsequently, analyses were stratified according to age, sex and type of index fracture.
A total of 624,460 subjects were included; 312,230 subjects with an index fracture, matched to 312,230 fracture-free controls (71% females, mean age 70 ± 12, mean follow-up 6.5 ± 5 years). The RR of falls was highest in the first year after fracture compared to fracture-free controls; males had a 3-fold and females a 2-fold higher risk. This imminent fall risk was present in all age and fracture types and declined over time. A concurrent imminent fracture and mortality risk were confirmed.
CONCLUSION/DISCUSSION: This study demonstrates an imminent fall risk in the first years after a fracture in all age and fracture types. This underlines the need for early fall risk assessment and prevention strategies in 50+ adults with a recent fracture.
近期发生骨折的成年人有很高的再次骨折的风险。我们假设，与再次骨折风险一样，骨折后立即发生跌倒的风险也最高。本研究旨在评估与无骨折的患者相比，近期骨折患者的跌倒风险是否与时间相关。
这是一项回顾性匹配队列研究，使用了英国临床实践研究数据链接 GOLD 的数据。在 1993 年至 2015 年间，确定了所有年龄≥50 岁的骨折患者，并根据年龄、性别和实践情况，与无骨折的对照组进行一对一匹配。在不同的时间间隔内，计算首次跌倒的累积发生率和相对风险 (RR)，以死亡率为竞争风险。随后，根据年龄、性别和索引骨折类型对分析进行分层。
共纳入 624460 例患者；312230 例患者发生了指数骨折，与 312230 例无骨折的对照组相匹配（71%为女性，平均年龄 70±12 岁，平均随访 6.5±5 年）。与无骨折的对照组相比，骨折后第一年的跌倒风险最高；男性的风险增加了 3 倍，女性的风险增加了 2 倍。这种即时的跌倒风险在所有年龄和骨折类型中都存在，并随着时间的推移而下降。同时也证实了存在即时骨折和死亡率风险。
结论/讨论：本研究表明，所有年龄和骨折类型的患者在骨折后最初几年内都存在即时跌倒风险。这强调了在 50 岁以上近期发生骨折的成年人中，早期进行跌倒风险评估和预防策略的必要性。
