title: FRAX (Aus) and falls risk: Association in men and women.
abstract: OBJECTIVE
  The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX.
  
  
  METHODS
  Clinical risk factors were documented for 735 men and 602 women (age 40-90 yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall.
  
  
  RESULTS
  There was an association between FRAX (hip with BMD) and EFST scores (β = 0.07, p < 0.001). After adjustment for sex and age, the relationship became non-significant (β = 0.00, p = 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05).
  
  
  CONCLUSIONS
  There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia. Electronic address: KHOLLO@BarwonHealth.org.au.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Holloway
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Australia; Barwon Health, Geelong, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowicz
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia; Barwon Health, Geelong, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lane
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Australia; Australian Institute of Musculoskeletal Sciences, The University of Melbourne, Melbourne, Australia.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Australia; Barwon Health, Geelong, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015519:Bone Density; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Elderly Falls Screening Test; FRAX score; Falls risk; Fracture prediction