Bone Abstracts

Introduction: Fragility fractures are a major cause of morbidity in older adults and are often preceded by falls. This study examines the differential effects of a history of single and recurrent falls on the incidence of subsequent re-fracture and mortality.

Methods: Patients with fragility fractures reviewed by the Aneurin Bevan University Health Board Fracture Liaison Service (AB-FLS) between January 2022 and December 2024 were included (n6,786). Falls risk assessment was completed for 4,393 patients (64.7%), while fall frequency data were available for 2,837 patients (41.8% of the cohort), representing a study limitation. Outcomes of interest were incident re-fracture and all-cause mortality, ascertained retrospectively over a maximum follow-up period of four years, ending on 31 December 2025.

Results: The mean age of the cohort was 79.2±2.7 years (range 50.1102.5), and 76.2% were women (n 3,346/4,393). Only 5.5% of patients were admitted from care homes (n370/6,786). Of the 2,837 patients with documented fall frequency, 62.6% (n1,776) reported a single fall, while 37.4% (n1,061) reported recurrent falls. Patients with a history of a single fall were younger than those with recurrent falls (mean age 77.9±15.7 years [range 50.1100.1] vs 79.9±4.5 years [range 53.7101.0]). At one year, mortality was 7.8% in patients with a single fall history (n 139/1,776) and 11.4% in those with recurrent falls (n121/1,061), with this difference reaching statistical significance (P 0.0013). Over four years of follow-up, 404 deaths were recorded, with lower mortality among patients with single falls compared with recurrent falls (11.5% [n205/1,776] vs 18.7% [n199/1,061]; p 0.0001). During the observation period, 482 patients sustained a re-fracture. Re-fracture rates were significantly lower in patients with a history of a single fall compared with those reporting recurrent falls (14.0% [n248/1,776] vs 22.1% [n234/1,061]; p 0.0001).

Conclusion: This study demonstrates a clear association between a history of recurrent falls and an increased risk of mortality and re-fractures over four years of follow-up. Our study recommends a need for enhanced, targeted fall-prevention strategies and structured follow-up for patients with fragility fractures, particularly those with recurrent falls to improve long-term clinical outcomes.