SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2024
A meta-analysis of previous falls and subsequent fracture risk in cohort studies.
Erratum issuedOpen access · greenAbstract readMeta-Analysis
In one paragraph
Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 40 papers, 7 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 7 pooled it
64.1field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 7 syntheses or guidelines pooled it, 56 citations in OpenAlex.
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- Effectiveness of an improved fall risk assessment form combined with obstacle physical activity testing in preventing falls in older adults hospitalized patients.Frontiers in public health · 2025Trial
- The phenotype of pelvic and acetabular fractures in adults aged 50 and older: a national database analysis in the Netherlands.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Fracture probability is predictive of fall-associated hospitalization: the Manitoba BMD Registry.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Article
- Management of postmenopausal osteoporosis.Endocrine reviews · 2026Review
- Frailty Predicts Incident Osteoporotic Fractures in Veterans with Rheumatoid Arthritis.Arthritis care & research · 2026Article
- To fall or not to fall: the question of hip fracture prevention.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Article
- Fragility fractures of the pelvis and long-term outcomes among older adults with osteoporosis: a real-world cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Muscle Function and Bone Strength in Children and Adolescents with Tall Stature.Hormone research in paediatrics · 2026Article
- High disease activity is associated with incident osteoporotic fractures among veterans with rheumatoid arthritis.Joint bone spine · 2026Article
- Analysis of risk factors and development of a predictive model for new vertebral fractures subsequent to percutaneous kyphoplasty in patients with single-segment osteoporotic vertebral compression fractures.BMC musculoskeletal disorders · 2026Article
- Comment on "Effect of protein supplementation on hip bone mineral density, cortical thickness, and bone strength in older adult participants during a caloric restriction and aerobic exercise weight loss intervention: a randomized controlled trial" (Osteoporosis International, 2026).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Authors' reply to 2nd comment on: effect of protein supplementation on hip bone mineral density, cortical thickness, and bone strength in older adult participants during a caloric restriction and aerobic exercise weight loss intervention: a randomized controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Fall-related deaths and acute healthcare utilisation in the last year of life among older adults in Latvia.Scientific reports · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
87 authors at 20 institutions in 24 countries.
Liesbeth VandenputMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.ORCID http://orcid.org/0000-0002-1712-6131
Helena JohanssonMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Eugene V McCloskeyCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.ORCID http://orcid.org/0000-0003-0177-8140
Enwu LiuMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Marian SchiniDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Kristina E ÅkessonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Fred A AndersonGLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
Rafael AzagraDepartment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Cecilie L BagerNordic Bioscience A/S, Herlev, Denmark.
Charlotte BeaudartWHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Heike A Bischoff-FerrariDepartment of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland.
Emmanuel BiverDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Olivier BruyèreWHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Jane A CauleyDepartment of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Jacqueline R CenterSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
Roland ChapurlatINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
Claus ChristiansenNordic Bioscience A/S, Herlev, Denmark.
Cyrus CooperMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Carolyn J CrandallDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Steven R CummingsSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
José A P da SilvaCoimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Bess Dawson-HughesBone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA.
Adolfo Diez-PerezDepartment of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
Alyssa B DufourMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
John A EismanSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
Petra J M EldersDepartment of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Serge FerrariDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Yuki FujitaCenter for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan.
Saeko FujiwaraDepartment of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
Claus-Christian GlüerSection Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
Inbal GoldshteinMaccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
David GoltzmanDepartment of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
Vilmundur GudnasonIcelandic Heart Association, Kopavogur, Iceland.
Jill HallMRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
Didier HansInterdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
Mari HoffDepartment of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
Rosemary J HollickAberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK.
Martijn HuismanDepartment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Masayuki IkiDepartment of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.
Sophia Ish-ShalomEndocrine Clinic, Elisha Hospital, Haifa, Israel.
Graeme JonesMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Magnus K KarlssonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Sundeep KhoslaRobert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Douglas P KielDepartment of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Woon-Puay KohHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Fjorda KoromaniDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Mark A KotowiczIMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia.
Heikki KrögerDepartment of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
Timothy KwokDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Olivier LamyCentre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
Arnulf LanghammerHUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Bagher LarijaniEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Kurt LippunerDepartment of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland.
Fiona E A McGuiganClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Dan MellströmGeriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Thomas MerlijnDepartment of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Tuan V NguyenSchool of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
Anna NordströmSchool of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Peter NordströmDepartment of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Terence W O'NeillNational Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Barbara Obermayer-PietschDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.
Claes OhlssonSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Eric S OrwollDepartment of Medicine, Oregon Health and Science University, Portland, OR, USA.
Julie A PascoIMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia.
Fernando RivadeneiraDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Anne-Marie SchottUniversité Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
Eric J ShiromaLaboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA.
Kristin SiggeirsdottirIcelandic Heart Association, Kopavogur, Iceland.
Eleanor M SimonsickTranslational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA.
Elisabeth Sornay-RenduINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
Reijo SundKuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
Karin M A SwartDepartment of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Pawel SzulcINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
Junko TamakiDepartment of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
David J TorgersonYork Trials Unit, Department of Health Sciences, University of York, York, UK.
Natasja M van SchoorDepartment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Tjeerd P van StaaCentre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.
Joan VilaStatistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
Nicholas J WarehamMRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
Nicole C WrightDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Noriko YoshimuraDepartment of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
M Carola ZillikensDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Marta ZwartPRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain.
Nicholas C HarveyMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Mattias LorentzonMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
William D LeslieDepartment of Medicine, University of Manitoba, Winnipeg, MB, Canada.
John A KanisMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@sheffield.ac.uk.ORCID http://orcid.org/0000-0002-3129-4326
Université Claude Bernard Lyon 1 · FRAustralian Catholic University · AULund University · SENorwegian University of Science and Technology · NOUniversity of Geneva · CHUppsala University · SEBarwon Health · AUChinese University of Hong Kong · HKDeakin University · AUManchester Academic Health Science Centre · GBMedical University of Graz · ATMRC Centre for Reproductive Health · GBNational Institute on Aging · USSahlgrenska University Hospital · SETufts University · USUniversitat Autònoma de Barcelona · ESUniversity of Aberdeen · GBUniversity of Bern · CHUniversity of California, Los Angeles · USUniversity of Cambridge · GB
Funding
Medical Research Council G0400491Medical Research Council G0601019Medical Research Council G1000143Medical Research Council MC_PC_21000Medical Research Council MC_PC_21001Medical Research Council MC_PC_21003Medical Research Council MC_PC_21022Medical Research Council MC_U147585819Medical Research Council MC_U147585824Medical Research Council MC_U147585827Medical Research Council MC_UP_A620_1014Medical Research Council MC_UP_A620_1015Medical Research Council MC_UU_00006/1Medical Research Council MC_UU_12011/1Medical Research Council MC_UU_12011/2Medical Research Council MR/J000094/1Medical Research Council MR/P020941/1
Abstract
The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm.
introductionPrevious falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD).
methodsThe resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients.
resultsFalls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33-1.51) and men (HR 1.53, 95% CI 1.41-1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27-1.84) in men vs. HR 1.32 (95% CI 1.20-1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men.
conclusionsA previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.
Indexed as
Hip FracturesOsteoporotic FracturesBone DensityCohort StudiesFemaleHumansMaleProspective StudiesRisk AssessmentRisk Factorsfracture riskhip fracturemajor osteoporotic fracturemeta-analysisprevious fallsrisk factors
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