The relationship among history of falls, osteoporosis, and fractures in postmenopausal women

Objective: To study the relative contribution of osteoporosis and falls to the occurrence of symptomatic fractures in postmenopausal women. Design: Retrospective survey of current osteoporosis in relation to falls and fractures in the preceding year. Setting: Patients of general practitioners of the area around a Belgian university. Participants: A total of 2649 consecutive postmenopausal women (mean age, 61y; range, 45-91y). Interventions: Not applicable. Main Outcome Measures: Current bone density measurements (single-photon absorptiometry in the forearm) were analyzed in relation to self-reported incidence of falls and fractures in the preceding year. Results: Osteoporosis was found in 15% of the patients, 19% reported I or more falls during the preceding year, and 1.8% had a fracture during the preceding year. The age-adjusted risk for a fracture in the past 12 months for a I standard deviation decrease in bone density was 1.9 (95% confidence interval [CI], 1.4-2.5; P<.01). Adjusted risk for age, bone density, and body mass index (BMI) for a fracture in the past 12 months in patients who reported a fall was 6.0 (95% Cl, 3.1-11.5; P<.001). Compared with women without osteoporosis and without a fall, women with osteoporosis without a fall had an age- and BMI-adjusted fracture risk of 2.8 (95% CI 0.6-12.8; P<.10), and women with osteoporosis and a fali had an adjusted-fracture risk of 24.8 (95% CI, 6.9-88.6; P<.0001). Conclusions: Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age and osteoporosis.