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

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 countymatched controls were investigated. ResultsThe 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 )) 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 , respectively) and men ) and HR 1.84(1.12-3.02), respectively), with an eating disorder. ConclusionThe 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.

Fracture Risk in Patients with Anorexia Nervosa Over a 40-Year Period

“…Moreover, we found no overall increased fracture risk in males with AN, but there was a trend toward an increased risk of major osteoporotic fractures, with a clear increased fracture risk at the femur (aHR 2.67) and spine (aHR 2.31). Our findings on AN-associated fracture risk are in line with previous studies on long-term fracture risk, (2,19,21,24,25) although we report a lower fracture risk (overall 46% increased risk) compared to other studies (increased risk of about 90% to 190%), (2,21) which may be due to several factors. Some studies included patients primarily from highly specialized treatment facilities or mostly hospitalized patients.…”

“…With an even larger male population, our results agree with those obtained by Nagata et al, (24) including an increased risk after the age of 35 years. The overall increased fracture risk described in the study by Axelsson et al (25) could be due to the higher average age (42 years) in their study compared to a median age in our study among males of 15.6 years. Fracture rate in the younger males from the general population is relatively high, (24,25) and young males with AN may have a different behavioral pattern compared to healthy young males regarding, for example, sporting activity (i.e., males with AN may avoid team or adventure sports) and other fracture risk behaviors.…”

“…(22,23) Only three previous large register-based studies on fracture risk in patients with eating disorders have included both males and females. (21,24,25) Two studies have stratified their analyses based on sex, (24,25) but only one assessed the fracture risk solely in AN, (24) reporting no overall increased risk in males, except from males >40 years of age. (24) The numbers of patients diagnosed with AN in recent decades has increased particularly in the younger age groups, (26,27) and during the same period treatment has become more specialized, with a focus on early interventions.…”

Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis

“…In a study with 130 women with AN, 54% had osteopenia and 38% osteoporosis [ 8 ]. A large Swedish study by Axelsson et al [ 9 ] with over 9000 patients with EDs of both male and female sex, found risk of fractures increased irrespective of age and sex. Longitudinal studies of patients with AN by Lucas et al [ 10 ] and Frølich et al [ 11 ] show that the fracture risk remains elevated several decades after initial diagnosis and even after remission compared to that in healthy controls (HC).…”

Prevalence and characteristics of registered falls in a Belgian University Psychiatric Hospital

“…Zhu et al ( 16 ) recently showed that elevated depressive symptoms in Chinese people are associated with an increased risk for falls and hip fractures. A recent Swedish study showed that the risk of injurious falls is increased in both women and men with eating disorders ( 17 ). The higher incidence of falls in this psychiatric population can partially be explained by the high use of psychotropic medication.…”