1. For healthy elderly patients randomized to take low-dose aspirin for 4 weeks, there was no difference in occurrence of fractures, but a higher occurrence of serious falls prompting hospitalization, compared to patients taking placebo.
Evidence Rating Level: 1 (Excellent)
For elderly patients, falls and fractures are a major contributor to morbidity and mortality with 700,000 deaths associated with falls globally each year. Falls can be attributed to both environmental and physiologic factors, such as bone strength. Although a systematic review has found an association between taking aspirin and lower odds of fracture, this has not yet been investigated in randomized controlled trials. Therefore, the ASPREE-FRACTURE study was initiated in Australia. This was a double-blind trial, comparing fall and fracture outcomes for otherwise healthy individuals aged 70 and older, randomized to take low-dose 100 mg aspirin or placebo, for 4 weeks. The measured outcomes included prevalence of fracture and serious falls prompting presentation to hospital. In total, there were 16,703 participants, 55.0% women, with 8,322 randomized to aspirin and 8,381 to placebo. The median (IQR) age was 74 (72-78) years, and the median follow-up was 4.6 years. The study found 2,865 fractures and 1,688 serious falls. There was no significant difference in the occurrence of first fractures (hazards ratio 0.97, 95% CI 0.87-1.06, p = 0.50) or recurrent fractures (HR 0.96, 95% CI 0.87-1.06, p = 0.40). However, more individuals in the aspirin group experienced serious falls, with 750 (9.0%) compared to 687 (8.2%), which was significantly different (incidence rate ratio 1.17, 95% CI 1.03-1.33, p = 0.01). Overall, this study demonstrated that healthy elderly patients taking low-dose aspirin had no difference in occurrence of fractures, but did have a significantly higher occurrence of serious falls.
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