105 Estimation of fear of falling and confidence in patients with vertebral fractures: a five-year prospective study based on a cohort of older women

Abstract

Background: Vertebral fractures (VFs) are common and one of the most adverse outcomes of osteoporosis. We have previously shown that people with VF have reduced physical activity (PA). The higher risk of falls in this group, which we have also observed, may indirectly contribute to their lower PA levels through fear of falling, which is expected to affect participation in a wide range of activities. Methods: This study is a prospective analysis of 395 women from a mixed community and secondary care based cohort with a mean of 5.4 years of follow up. The study included participants from two different studies: 290 from the Cohort for Skeletal Health in Bristol and Avon (COSHIBA) and 105 from another research study recruited to investigate the association between VF and back pain. Lateral spine radiographs were taken at baseline, and vertebrae from T4 to L4 were evaluated using the quantitative morphometric (QM) approach. VF were defined either as a definite VF (≤25% decreased in height) or doubtful VF (20%-< 25% decreased in height). Fear of falling was assessed by the Tinetti falls efficacy scale (FES), and general confidence using a validated question from the Warwick-Edinburgh mental well-being scale (WEMWBS). Analyses were adjusted for age (model 1) and additional confounders, namely alcohol, self-reported health, osteoporosis, use of stairs, walking speed, and falls (model 2) as assessed at follow-up Results: 395 women in total were recruited to this study, 286 without VF, 58 with doubtful VF, and 69 with definite fracture. Those with definite fracture were older than women without fracture (mean age of 77.6 vs 72.2). Women with definite fracture also had worse general health and were frailer. For FES, in model 1, there was a clear association between definite VF and fear of falling on reaching into cabinets or closets (OR 3.04, 95%CI (1.25 to 6.10), P=0.002), and getting dressed and undressed (OR 3.23, 95%CI (1.34 to 7.77), P=0.048). In model 1, there was also an inverse association between definite VF and general confidence (OR 2.25, 95%CI (1.06 to 4.76), P=0.033). Associations between VF and FES and general confidence were essentially unchanged after adjustment for additional confounders (model 2). Conclusion: This is the first prospective study to explore the association between VF and fear of falling and general confidence. Women with VF are less confident than those without fracture, and have greater fear of falling, which may contribute to their lower PA levels.