Association Of Peripheral Neuropathy With Injurious Falls And Fractures In The Atherosclerosis Risk In Communities Study

Background: Peripheral neuropathy (decreased sensation in the foot) as assessed by monofilament testing is associated with all-cause and cardiovascular mortality. We aimed to assess the association of peripheral neuropathy with incident injurious falls and fractures in older adults. Methods: All black and white participants in the Atherosclerosis Risk in Communities Study (ARIC) who underwent monofilament testing at visit 6 (2016-2017) were included. Incident injurious falls and fractures were identified based on ICD-9 and -10 codes from active surveillance of all hospitalizations and linkage to Medicare claims. We used Kaplan Meier curves and Cox regression to assess the association of peripheral neuropathy with injurious falls and fractures (combined and as separate outcomes) after adjusting for demographics, diabetes status, and risk factors for falls. Results: There were 3,597 ARIC participants (mean age 79.4, SD 4.7 years), of which 1,236 (34.4%) had peripheral neuropathy based on monofilament testing. During a median follow-up of 2.5 years, 371 participants had a documented fall and 475 participants had a documented fracture. The incidence rate (per 1,000 person-years) for incident injurious falls/fracture, falls, and fractures was higher for participants with peripheral neuropathy compared to those without ( Table ). After adjustment, peripheral neuropathy was consistently and independently associated with all outcomes. Further adjustment for cognitive status, medication use, prior fall or fractures, and analyses accounting for the competing risk of death did not substantially change our results. Conclusions: Peripheral neuropathy as measured by monofilament testing is associated with incident injurious falls and fracture in older adults. Screening with monofilament testing is inexpensive and simple and may be warranted to identify older adults at high risk for falls.