Osteoporosis: a missed link in fall prevention - a retrospective cohort study

Falls and osteoporotic fractures are common in the geriatric population. Although falls increase the risk of osteoporotic fractures, many patients with recurrent falls are untreated for osteoporosis. In our study, we aimed to; (1) assess the incidence of fractures among patients who experience falls during inpatient care in a geriatric ward; (2) investigate the risk factors associated with fractures in this cohort; and (3) investigate whether patients on anti-osteoporotic treatment differed from and had better fall-related clinical outcomes compared to those without anti-osteoporotic treatment. This study involved a retrospective cohort analysis of inpatient falls in the Geriatric ward between 2018 and 2020. Patients who experienced a fall during this period were identified through the hospital’s adverse event tracking system. Demographic and clinical data, fall-related information, associated risk factors and outcomes were extracted from the hospital’s electronic medical records. A total of 159 patients with fall incidents were included, with the mean age of the patients being 84 ± 7 years, and 45% of them being female. Among these patients, 9% sustained a fracture during the fall, with hip and vertebral fractures being the most common types. Nearly half of the patients who had fallen (42%) had experienced at least one previous fracture. None of the patients who sustained a fracture during inpatient care were currently receiving anti-osteoporotic treatment, compared to 8% in the non-fracture group. Most patients (97%) were considered to have a high risk of falling (Downton fall risk index ≥ 3). Although risk assessments and interventions are conducted to prevent injurious falls, patients continue to experience falls. Despite being classified as high-risk fallers and having a history of previous fractures, only a minority of these patients are receiving anti-osteoporotic treatment. This shortfall could potentially contribute to the high incidence of fall-related fractures observed in this study. Fractures occurred in 9% of geriatric inpatients with a documented fall, with hip and vertebral fractures being the most common. None of the patients who sustained fractures were receiving anti-osteoporotic treatment, despite being classified as high-risk fallers. The underutilization of osteoporosis treatment in this vulnerable population may contribute to the high incidence of fall-related fractures.