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GPs advised to ask about recent falls to assess fracture risk

Simply asking older women if they have fallen in the past year is the best way to assess fracture risk, say researchers.

Their study shows that more than one fall a year is at least twice as important as height and weight, but because many falls go unreported, GP records alone cannot be relied upon to determine a patients risk, the University of Bristol team said.

The Arthritis Research UK funded study of 3,200 post-menopausal women in their seventies found that 26% had suffered a fracture since the age of 50.

More than half of those reported falling more than once a year, but 69% had no mention of falls on their computerised GP record.

Age, weight and height were all found to be independent risk factors, but the strongest risk factor by far was falls more than once a year which increased the risk of fracture by 49%.

The researchers said this was the first report of the benefits, and quantification, of the self-reported falls to the list of clinical risk factors. Previous analyses using computerised GP records have probably underestimated the importance of falls in fracture prediction, they concluded in Age and Ageing.

Study leader Dr Emma Clark, consultant senior lecturer in rheumatology said she was not surprised to find falls were strongly associated with fracture risk but expected stronger associations with other factors.

She said: ‘Other risk factors really did not appear to be that important in this large group and it shows that a lot of these risk factors we ask about are fairly unusual.

‘It highlights that we should be asking about falls more than we are,' she added.

‘If they are falling more than once a year, that should be a red flag and there are really good falls services available that primary care can refer directly to and there are simple good cost effective interventions available that are just as effective as bisphosphonates,' she said.

Dr Alun Cooper, a GPSI in osteoporosis in Crawley, West Sussex, said: ‘Most fragility fractures result from a fall, yet falls are under reported and under recorded in GP databases.'

‘This study highlights the need to address this in practice and then to use the information to calculate the patients risk of fracture,perhaps using the WHO Fracture Risk Assessment tool – FRAX.'

Age and Ageing, published online 21 November

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