November 23, 2022
2 min learn
Barker experiences grants from the Nationwide Well being and Medical Analysis Council of Australia (NHMRC) exterior the submitted work. Please see the examine for all different authors’ related disclosures.
For wholesome older sufferers, an aspirin a day doesn’t cut back fracture threat and would possibly enhance the chance for critical falls, in accordance with researchers.
“Falls and fractures are frequent and deleterious to the well being of older individuals,” Anna L. Barker, PhD, of the college of public well being and preventive medication at Monash College in Australia, and colleagues wrote of their article, printed in JAMA Inside Medication.
Aspirin has beforehand been mentioned to assist shield bone fragility and sluggish bone loss, they wrote. So, the researchers performed a substudy of the ASPREE randomized scientific trial to higher perceive if a each day dose of 100 mg of aspirin can cut back fracture or critical fall threat in wholesome older adults.
Primarily on the lookout for fracture incidence and critical falls that end in hospital presentation, the researchers evaluated knowledge from greater than 16,000 individuals with a median age of 74 years, 55% of whom had been ladies.
Barker and colleagues recognized 2,865 fractures and 1,688 critical falls over a follow-up interval of 4.6 years. There was no distinction between the intervention and management teams when it got here to the chance for first fracture (HR = 0.97; 95% CI, 0.87-1.06), however aspirin was considerably related to an elevated threat for critical falls (whole falls, 884 vs. 804; incidence charge ratio = 1.17; 95% CI, 1.03-1.33).
Regardless of analyses that adjusted for covariates recognized to have an effect on fall and fracture threat, the “outcomes remained unchanged,” the researchers wrote.
Slightly below 10% of members within the aspirin group skilled 884 critical falls, whereas 8.2% individuals within the placebo group skilled 804 critical falls (incidence charge ratio = 1.17; 95% CI, 1.03-1.33).
“These receiving aspirin skilled a larger variety of critical falls, both single or a number of, which required hospital presentation, with or with out accompanying fractures,” Barker and colleagues wrote.
Consistent with earlier experiences that point out solely 10% to fifteen% of falls in older persons are accompanied by fractures, “the rise in critical fall threat was not accompanied by a rise in fractures,” Barker and colleagues wrote.
“Extra doubtless, it could have resulted from extra in depth bleeding or bruising after a fall resulting in a necessity for extra medical consideration,” the researchers wrote. “Alternatively, a rise within the tendency to fall could have resulted from different aspirin-induced morbidities similar to anemia.”
The truth that low-dose aspirin failed to cut back fracture threat and as an alternative elevated critical fall threat “provides to the physique of proof that this agent offers little favorable profit in a wholesome, white older grownup inhabitants,” the researchers concluded. This isn’t what they anticipated.
“The rise in critical falls noticed amongst these randomized to aspirin was not anticipated and might need resulted from both an elevated tendency to fall or extra substantial non-fracture accidents sustained as a consequence of falling. It was initially hypothesized that aspirin could lower falls by slowing bodily decline by lowering cardiovascular and cerebrovascular occasions by way of antiplatelet results and/or lowering cognitive decline by defending in opposition to Alzheimer’s illness and/or vascular dementia — well-known fall threat elements.”
By way of scientific implications, Barker and colleagues wrote that the “significance of those outcomes pertains to the big share of the older inhabitants who’re each liable to fracture and are taking aspirin for the prevention of cardiovascular and cerebrovascular illness.”
“Regardless of promising findings from each in vitro and observational research, aspirin doesn’t cut back the chance of fractures in wholesome older individuals and is unlikely both to extend or lower the group burden of fractures,” they wrote.