Fall and Bone-Related Risk Factors in Individuals with Fragility Fractures of the Distal Radius: Are We Adequately Addressing Secondary Prevention of Falls and Fractures?

INTRODUCTION: Fragility fractures indicate a significant risk for future fractures and necessitate referrals for comprehensive evaluation and risk reduction. Although clinical guidelines describe best practice for falls and fracture prevention, clinical use of these guidelines may be inadequate. The purpose of this study was to describe fall and bone-related risk factors associated with a positive fall history and referral patterns for physical therapy services in persons with a fragility fracture. METHODS: A comprehensive survey to identify risk factors for osteoporosis, future fracture, and falls, was distributed to 264 adults who sustained a distal radius fragility fracture; 100 adults were included in this study. Chi-square, Fisher’s Exact tests, and odds ratios were performed to analyze associations between risk factors, post-fracture fall history, and referral for exercise. RESULTS: A positive fall history post-fracture was reported by 25% of the sample and 41% reported 3 or more fall-related risk factors. Positive history of near falls (OR=16.55), fear of falling (OR=5.42), poor self-rated general health (OR=4.28), and no prescription for calcium/vitamin D supplementation (OR=7.00) were significantly associated with positive fall history post-fracture. Only 16% of the sample was referred for exercise or fall prevention post-fracture. Referral for osteoporosis evaluation (OR=3.28) and calcium supplement prescription (OR=3.21) were the only factors significantly associated with referral for exercise. There was no referral for exercise in 80% of subjects who experienced frequent falls post-fracture. CONCLUSIONS: These results illustrate a gap between best practice guidelines for secondary prevention and current clinical management in individuals with fragility fracture