title: Primary biliary cirrhosis is associated with falls and significant fall related injury.
abstract: BACKGROUND
  Osteoporosis and autonomic dysfunction are prevalent in the autoimmune liver disease primary biliary cirrhosis (PBC). Postural hypotension is one consequence of autonomic dysfunction and is a recognized risk factor for falls, which, alongside osteoporosis could lead to significant injury and fractures.
  
  
  OBJECTIVE
  To determine the prevalence and sequelae of falls in PBC and to identify modifiable risk factors.
  
  
  METHODS
  Cross-sectional, geographical, population census of PBC and two control groups: primary sclerosing cholangitis and a community dwelling population. Multidisciplinary falls assessment of a representative group of PBC.
  
  
  METHODS
  Symptom assessment tools, completed by the three cohorts, determined the prevalence of falls, injuries and associated symptoms. Multidisciplinary assessments, adhering to NICE guidelines, identified modifiable fall associations.
  
  
  RESULTS
  Significantly more of the PBC population had fallen (72% P < 0.001) than both control groups. Fifty-five percent had fallen in the last year (P < 0.001), and 22% more than once in the last year (P < 0.01). Seventy percent of PBC fallers were injured, 27% fractured a bone and 19% were admitted to hospital, all significantly more common than controls. Postural dizziness was significantly worse in fallers (P < 0.001), as were balance (P < 0.001) and lower limb strength (P = 0.002). Lower limb strength was independently associated with number of falls in previous year (beta = 0.184, P < 0.001).
  
  
  CONCLUSIONS
  Falls and resultant injury are prevalent in PBC and more common than previously recognized. Addressing postural dizziness, poor balance and lower limb weakness using a multidisciplinary approach has the potential to reduce falls, morbidity and mortality and as a result improve quality of life.
authors.affiliation: UK National Institute for Health Research, Biomedical Research Centre in Ageing-Liver Theme, Newcastle University, Newcastle NE2 4HH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Frith
authors.forename: S
authors.initials: S
authors.lastname: Kerr
authors.forename: L
authors.initials: L
authors.lastname: Robinson
authors.forename: C
authors.initials: C
authors.lastname: Elliott
authors.forename: C
authors.initials: C
authors.lastname: Ghazala
authors.forename: K
authors.initials: K
authors.lastname: Wilton
authors.forename: J
authors.initials: J
authors.lastname: Pairman
authors.forename: D E J
authors.initials: DE
authors.lastname: Jones
authors.forename: J L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D004244:Dizziness / Q000453:epidemiology / Q000209:etiology; D016021:Epidemiologic Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology