Eating disorders are associated with increased risk of fall injury and fracture in Swedish men and women

K F Axelsson; M N Woessner; H Litsne; M Wheeler; A Flehr; A J King; M Kalén; L Vandenput; M Lorentzon

doi:10.1007/s00198-022-06312-2

Eating disorders are associated with increased risk of fall injury and fracture in Swedish men and women

Osteoporos Int. 2022 Jun;33(6):1347-1355. doi: 10.1007/s00198-022-06312-2. Epub 2022 Jan 27.

Authors

K F Axelsson^{1

2}, M N Woessner³, H Litsne¹, M Wheeler⁴, A Flehr⁴, A J King⁴, M Kalén⁵, L Vandenput^{1

4}, M Lorentzon^{6

7

8}

Affiliations

¹ Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Region Västra Götaland, Närhälsan Norrmalm Health Centre, Skövde, Sweden.
³ Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia.
⁴ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
⁵ Region Västra Götaland, Department of Psychiatry, Skaraborgs Hospital, Skövde, Sweden.
⁶ Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. mattias.lorentzon@medic.gu.se.
⁷ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. mattias.lorentzon@medic.gu.se.
⁸ Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Building K, 6th Floor, 431 80, Mölndal, Sweden. mattias.lorentzon@medic.gu.se.

Abstract

In this retrospective cohort study, men and women with eating disorders (n = 8867) had higher risk of injurious falls and hip fractures than age, sex, and county-matched controls (n = 88670).

Introduction: Eating disorders have been associated with decreased bone mineral density and increased fracture risk, but the association with fall injuries without fracture has not previously been investigated. Furthermore, fracture risk in men with eating disorders has been insufficiently studied.

Methods: In the present study, 8867 patients (9.4% men) with a diagnosed eating disorders and 88670 age-, sex-, and county-matched controls were investigated.

Results: The mean (standard deviation) age of the patients and controls was 41.6 (13.7) years and the follow-up time 9.6 (5.2, 14.4) years (median, interquartile range) for patients and 10.1 (5.5, 14.2) years for controls. The proportions of injurious falls without fracture (17.3% vs. 9.0%) and of hip fracture (1.6% vs. 0.7%) were substantially greater in patients with an eating disorder than in their corresponding population controls. In an unadjusted Cox proportional hazards model, individuals with an eating disorder had a higher risk of injurious falls without fracture (Hazard ratio (HR) 95% confidence interval (CI): 2.07 (1.96-2.18), and hip fracture (HR 2.30 (1.92-2.75)) than the risk observed in the controls. The HR for any investigated outcome associated with an eating disorder did not differ by sex or age (interaction term p > 0.10). The risk of injurious falls without fracture and hip fracture was increased in both women (HR 2.07 (1.95-2.19) and HR 2.41 (1.98-2.93), respectively) and men (HR 2.09 (1.76-2.49) and HR 1.84(1.12-3.02), respectively), with an eating disorder.

Conclusion: The risk of injurious falls without fracture and of hip fracture is increased in both women and men with eating disorders, indicating measures to prevent both falls and fractures are important in these patients, regardless of age and sex.

Keywords: Eating disorders; Falls; Fracture.

MeSH terms

Bone Density
Child
Feeding and Eating Disorders* / complications
Feeding and Eating Disorders* / epidemiology
Female
Hip Fractures* / epidemiology
Hip Fractures* / etiology
Humans
Male
Retrospective Studies
Risk Factors
Sweden / epidemiology