Osteoporosis International

, Volume 30, Issue 11, pp 2205–2215 | Cite as

Influence of fall environment and fall direction on risk of injury among pre-frail and frail adults

  • S. K. Gratza
  • P. O. Chocano-Bedoya
  • E. J. Orav
  • M. Fischbacher
  • G. Freystätter
  • R. Theiler
  • A. Egli
  • R. W. Kressig
  • J. A. Kanis
  • H. A. Bischoff-FerrariEmail author
Original Article



In this prospective study, half of all falls resulted in injury. Pre-frail adults sustained more injuries, while more frail adults had injuries requiring hospitalization or fractures. Pre-frail adults fell more often when in movement compared with frail adults who fell more often when standing and in indoor public spaces.


To assess prospectively how fall environment and direction are related to injury among pre-frail and frail adults.


We included 200 community-dwelling adults with a prior fall (pre-frail, mean age 77 years) and 173 adults with acute hip fracture (frail, mean age 84 years; 77% community-dwelling). Falls were prospectively recorded using standardized protocols in monthly intervals, including date, time, fall direction and environment, and injury. We used logistic regression to assess the odds of injury adjusting for age, body mass index (BMI), and gender.


We recorded 513 falls and 331 fall-related injuries (64.5%) among the 373 participants. While the fall rate was similar between groups, pre-frail adults had more injuries (71% among pre-frail vs. 56% among frail, p = 0.0004) but a lower incidence of major injuries (9% among pre-frail vs. 27% among frail, p = 0.003). Pre-frail adults fell more often while in movement (84% among pre-frail vs. 55% among frail, p < 0.0001), and frail adults fell more often while standing (26% vs. 15% respectively, p = 0.01). The odds of injury among frail adults was increased 3.3-fold when falling sideways (OR = 3.29, 95% CI = 1.68–6.45) and 2.4-fold when falling in an indoor public space (OR = 2.35, 95% CI = 1.00–5.53), and was reduced when falling at home (OR = 0.55, 95% CI = 0.31–0.98). The odds of injury among pre-frail adults was not influenced by environment and was 53% lower when falling backwards (OR = 0.47, 95% CI = 0.26–0.82).


While pre-frail adults sustain more fall-related injuries, frail adults were more likely to sustain major injuries, especially when falling sideways or outside their home.


Falls Frail Injuries Pre-frail Prospective 


Funding information

The analysis was supported by the Baugarten Centre Grant to the Centre on Aging and Mobility. Regarding the pre-frail dataset, the primary funding sources were a Swiss National Foundations Professorship Grant PP00B-114864 (Bischoff-Ferrari) and The VELUX Foundation (Bischoff-Ferrari). Regarding the frail dataset, the primary funding sources were the Swiss National Foundation Grant NFP-53 (Bischoff-Ferrari) and Vontobel Foundation (Bischoff-Ferrari HA).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • S. K. Gratza
    • 1
    • 2
  • P. O. Chocano-Bedoya
    • 1
  • E. J. Orav
    • 3
  • M. Fischbacher
    • 1
    • 4
  • G. Freystätter
    • 1
    • 5
  • R. Theiler
    • 1
    • 5
  • A. Egli
    • 1
  • R. W. Kressig
    • 2
  • J. A. Kanis
    • 6
    • 7
  • H. A. Bischoff-Ferrari
    • 1
    • 5
    • 8
    Email author
  1. 1.Centre on Aging and MobilityUniversity Hospital Zurich, Waid City Hospital, and University of ZurichZurichSwitzerland
  2. 2.Basel University Medicine of Aging, Felix-Platter SpitalBaselSwitzerland
  3. 3.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  4. 4.School of Allied Health SciencesGriffith UniversityGold CoastAustralia
  5. 5.Department of Geriatrics and Aging ResearchUniversity Hospital ZurichZurichSwitzerland
  6. 6.Mary McKillop Health InstituteAustralian Catholic UniversityMelbourneAustralia
  7. 7.Centre of Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  8. 8.University Clinic for Acute Geriatric Care, City Hospital WaidZurichSwitzerland

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