Association between recurrent falls history on re-fracture risk and mortality: A 4-years Follow-up Study

Introduction: Fragility fractures are a major cause of morbidity in older adults and are often preceded by falls. Identifying patients at greatest risk of refracture is vital for optimising secondary prevention strategies within Fracture Liaison Service (FLS). This study measures impact of history of single or recurrent (2 or more) falls on the incidence of re-fracture and mortality among patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS).

Methods: This study included fragility fracture patients (n= 3839) reviewed by AB-FLS between January 2022 and December 2023. Falls risk assessment completed =2436 patients (63.4%). Fall frequency was completed in only 39.9% (n=1535/3839), which is a limitation of this study. Clinical outcomes included re-fracture rates and mortality over a total 4-years follow-up until 31st December, 2025 was completed retrospectively.

Results: The mean age was 79.1±9.6 years (range = 50-101). Women were 78.8% (n=3027). Only 5.9% (n=230/3839) patients were admitted from care homes.

A documented history of falls was available for 1,535 patients, of whom 60.9% (n = 935) reported a single fall and 39.1% (n = 600) reported recurrent falls. Patients with recurrent falls were older than those with a single fall (mean age 80.2 ± 8.3 years [range 54–101] vs 78.9 ± 9.4 years [range 50–100]).

At one year, mortality was 10.3% (n = 96/935) in patients with a history of a single fall and 13.3% (n = 80/600) in those with recurrent falls; this difference did not reach statistical significance (p = 0.07). Over four years, 275 deaths were recorded. Mortality was significantly higher among patients with recurrent falls compared with single fallers (22.6% [n = 136/600] vs 14.8% [n = 139/935], p = 0.001).

During the observation period, 296 patients sustained a re-fracture. Re-fracture rates were higher in patients with recurrent falls than in those with a single fall (24.5% [n = 147/600] vs 15.9% [n = 149/935]), although this difference was not statistically significant (p = 0.5).

Conclusion: This study demonstrates a clear association between a history of recurrent falls and an increased risk of mortality over four years of follow-up. These findings also highlight higher re-fractures in those with previous history of recurrent falls, which needs further evidence to confirm our findings. 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 reduce re-fracture risk and improve long-term clinical mortality risk.