Lorentzon Mattias, Johansson Helena, Harvey Nicholas C, Liu Enwu, Schini Marian, Vandenput Liesbeth, McCloskey Eugene, Kanis John A
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, University of Gothenburg, Gothenburg, Sweden.
Department of Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden.
Osteoporos Int. 2025 Aug 6. doi: 10.1007/s00198-025-07630-x.
Using data from a meta-analysis including 606,715 women, we found that the predictive value of a fall the past year for future hip fractures in women significantly decreases with age, resulting in a diminishing population attributable risk with increasing age.
In a recent meta-analysis of 40 cohorts, we demonstrated that a fall history in the past year was associated with an increased risk of hip fracture. An interaction between fall history and age was observed in women, with lower hazard ratios (HR) for older women. This study aimed to determine the population-attributable risk (PAR) for hip fracture due to increased fall risk in women of different ages.
Fall history associated attributable risk (AR, %) for hip fracture was calculated [100·(1-1/relative risk (HR))] for women per age stratum, using previously calculated HRs. PAR (%) of hip fractures in the female population (≥ 50 years) that could be prevented if the fall history-mediated risk increase could be eliminated was calculated as 100·P·(HR-1)/[1 + P·(HR-1)] where P was the exposed proportion of the population (i.e. the proportion with past falls).
A total of 606,715 women included from 40 cohorts, with fall risk documented in the past year (fall history yes/no or 2 or more falls) and prospective information about hip fracture and death, were analysed. The proportion of fallers increased progressively with age from 24.6% at age 50-54 years to 45.5% at age 90-94 years. In contrast, the AR due to falls decreased, from 54.8% at age 50-54 years to 8.3% at age 90-94 years, and the PAR diminished with age, from 23.9% in women 50-54 years old to 3.9% in women 90-94 years old.
As falls become more common with age, their predictive value for future hip fractures in women significantly decreases. This suggests that the effectiveness of fall prevention strategies in reducing hip fractures is lower in older women, who are at higher risk for serious falls and hip fractures.
利用一项纳入606,715名女性的荟萃分析数据，我们发现过去一年跌倒对女性未来髋部骨折的预测价值随年龄显著降低，导致人群归因风险随年龄增长而减少。
在最近一项对40个队列的荟萃分析中，我们证明过去一年的跌倒史与髋部骨折风险增加相关。在女性中观察到跌倒史与年龄之间存在交互作用，老年女性的风险比（HR）较低。本研究旨在确定不同年龄女性因跌倒风险增加导致髋部骨折的人群归因风险（PAR）。
使用先前计算的HR，计算每个年龄层女性因跌倒史导致的髋部骨折归因风险（AR，%）[100·(1 - 1/相对风险（HR）)]。如果可以消除跌倒史介导的风险增加，女性人群（≥50岁）中髋部骨折可预防的PAR（%）计算为100·P·(HR - 1)/[1 + P·(HR - 1)]，其中P是人群的暴露比例（即过去有跌倒的比例）。
对来自40个队列的总共606,715名女性进行了分析，这些女性在过去一年有跌倒风险记录（跌倒史是/否或跌倒2次或更多次），并具有关于髋部骨折和死亡的前瞻性信息。跌倒者的比例随年龄逐渐增加，从50 - 54岁的24.6%增至90 - 94岁的45.5%。相比之下，跌倒导致的AR从50 - 54岁的54.8%降至90 - 94岁的8.3%，PAR随年龄减少，从50 - 54岁女性的23.9%降至90 - 94岁女性的3.9%。
随着跌倒在老年人中变得更为常见，其对女性未来髋部骨折的预测价值显著降低。这表明预防跌倒策略在减少髋部骨折方面对老年女性的效果较低，而老年女性发生严重跌倒和髋部骨折的风险更高。
