A study was conducted that examined the relationship between low-dose aspirin and risk of fractures in older adults. It was actually a substudy of the ASPREE (Aspirin in Reducing Events in the Elderly) trial, conducted to investigate whether aspirin would help prolong the healthy lifespan in adults. Over a median follow-up of 4.6 years, there was no difference in the risk of first fracture between participants who were taking aspirin 100 mg daily and those taking placebo. However, aspirin was connected to a higher risk of serious falls, reported Anna L. Barker, PhD, of Monash University in Melbourne, Australia , and her co-authors of the study.
MedPage Today’s recent article entitled “Daily Aspirin No Help for Fracture Prevention in Seniors, Raises Risk of Falls” reports that the results didn’t change after adjusting for covariates known to influence fracture and fall risk, they noted in JAMA Internal Medicine.
“This finding adds to evidence from the ASPREE principal trial which showed that, among these participants, the use of low-dose aspirin did not confer any advantage in terms of disability-free survival (a composite that integrated the risks and benefits of aspirin),” they wrote.
“The increase in serious falls observed among those randomized to aspirin was not anticipated and might have resulted from either an increased tendency to fall or more substantial nonfracture injuries sustained as a consequence of falling,” they noted. “It was originally hypothesized that aspirin may decrease falls by slowing physical decline by reducing cardiovascular and cerebrovascular events through antiplatelet effects and/or reducing cognitive decline by protecting against Alzheimer disease and/or vascular dementia — well-known fall risk factors.”
Falls account for 95% of hip fractures and about 80% of traumatic brain injury-related hospital presentations and deaths in older adults. The burden of both falls and fractures is likely to increase with aging because the risks of both falls and fractures increase exponentially with age.
For the sub study, they recruited 16,703 community-dwelling older adults free of cardiovascular disease, dementia and physical disability from 2010 to 2014. The median age was 74, and 55% were women. Of the participants, half were randomly given aspirin and the others were given a placebo. Over follow-up, 2,865 fractures were recorded, as were 1,688 serious falls (884 in the aspirin arm vs 804 in the placebo arm).
The authors said the results are clinically relevant “to the large percentage of the older population who are both at risk of fracture and are taking aspirin for the prevention of cardiovascular and cerebrovascular disease. The lack of an effect of low-dose aspirin on the risk of fractures while increasing the risk of serious falls adds to the body of evidence that this agent provides little favorable benefit in a healthy, white older adult population.”
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Reference: MedPage Today (Nov. 7, 2022) “Daily Aspirin No Help for Fracture Prevention in Seniors, Raises Risk of Falls”