Association between fear of falling and single versus recurrent falls in patients with fragility fractures

Introduction: Fracture Liaison Service (FLS) assess patients for secondary prevention of fragility fracture. routinely assesses fall risk to prevent secondary fractures. Fear of falling is a common psychological consequence following falls and fragility fractures, contributing to functional decline, reduced quality of life, and increased risk of further falls and fractures. This study evaluates the relationship between fear of falling with respect to single or recurrent falls among patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS).

Methods: A retrospective cohort analysis was conducted on 6478 patients reviewed by AB-FLS between January 2022 and December 2024. Falls risk assessment was documented in 79.8% (n=5139 patients). Complete data on both falls frequency and fear of falling was only available in 43.7% (n=2835 patients), which is a limitation of this study. Data were stratified into recurrent falls (≥2 falls) and single fall groups.

Results: The mean age was 78.4±10.2 years (range = 50-105). Women were 77.3% (n=5007) and men were 22.7% (n=1471). Only 5.3% (n=345) patients were admitted from care homes. Single and recurrent falls occurred in 62.6% (n=1776/2835) and 37.4% (n=1059/2835) of patients respectively (p <0.0001). The mean age (SD, range) for patents with single falls and recurrent falls were 77.9±8.7 (50-100) and 79.9±8.8 (54-101) respectively (p<0.0001)

Fear of falling was reported by 31.1% (n=878/2835). Majority of patients (75.1%, n=659/878) who reported fear of falling have recurrent falls and in comparison, only 24.9% (n=219/878) patients with a single fall reported fear of falling, the difference being statistically significant (p<0.0001).

Conclusion: This study highlights a significant gap in clinical practice, with fear of falling not assessed in nearly half of patients presenting with fragility fractures. Consistent with existing literature, our findings demonstrate a strong association between recurrent falls and fear of falling. Patients with recurrent falls were three times more likely to report fear of falling compared with those who experienced a single fall. Fear of falling is recognised as both a consequence and a predictor of future falls, contributing to reduced mobility, activity avoidance, and further fracture risk. These findings reinforce the need for comprehensive falls assessments within Fracture Liaison Services (FLS) that extend beyond physical risk factors to include psychological determinants. Incorporating tailored, multidisciplinary interventions that address balance, strength, confidence, and fear-related behaviours is essential to reduce recurrent falls and optimise secondary fracture prevention.