Eating disorders such as anorexia nervosa and bulimia nervosa 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, due to a relatively low number of men in previous studies, fracture risk in men with eating disorders has been insufficiently studied.
In the present Swedish retrospective study, 8 867 patients (90.6% women) with a diagnosed eating disorder and 88 670 age, sex and county matched controls who had never been diagnosed with an eating disorder were investigated. The 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 unadjusted Cox proportional hazards models, 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 (HR 2.30, CI 1.92-2.75) 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 group (interaction term p>0.10). The risk of injurious falls without fracture and hip fracture was increased in both women (HR 2.07, CI 1.95-2.19 and HR 2.41, CI 1.98-2.93, respectively) and men (HR 2.09, CI 1.76-2.49 and HR 1.84, CI 1.12-3.02, respectively).
In conclusion, the risk of injurious falls without fracture and 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.