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The impact of nocturia on falls and fractures: a systematic review and meta-analysis

  • Pesonen JS,
  • Vernooij RWM,
  • Cartwright R,
  • Aoki Y,
  • Agarwal A,
  • Mangera A,
  • Markland AD,
  • Tsui JF,
  • Santti H,
  • Griebling TL,
  • Pryalukhin AE,
  • Riikonen J,
  • Tähtinen RM,
  • Vaughan CP,
  • Johnson TM 2nd,
  • Heels-Ansdell D,
  • Guyatt GH,
  • Tikkinen KAO

Publication: The journal of urology, July 2019

Purpose

Although nocturia is associated with various comorbidities, its impact on falls and fractures remains unclear. We performed a systematic review and meta-analysis to evaluate the association between nocturia with falls and fractures, both as a prognostic and causal risk factor.

Materials and methods

We searched PubMed, Scopus and CINAHL and abstracts of major urologic meetings up to December 31, 2018. We conducted random effects meta-analyses of adjusted relative risks (RR) of falls and fractures. We applied the GRADE approach to rate the quality of evidence for nocturia as a prognostic and causal factor of falls and fractures.

Results

Of 5230 potential reports, nine observational longitudinal studies provided data on the association between nocturia and falls or fractures (1 for both, 4 for falls, 4 for fractures). Pooled estimates demonstrated a risk ratio of 1.20 (95% confidence interval 1.05-1.37; I2=51.7%; annual risk difference 7.5% among the elderly) for association between nocturia and falls and 1.32 (95% confidence interval 0.99-1.76; I2=57.5%; annual risk difference 1.2%) for association between nocturia and fractures. Subgroup analyses showed no significant effect modification by age, gender, follow-up time, nocturia case definition or risk of bias. We rated the quality of evidence for nocturia as a prognostic factor as moderate for falls and low for fractures, and as very low as a cause of falls/fractures.

Conclusions

Nocturia is probably associated with an approximately 1.2-fold increased risk of falls and possibly with an approximately 1.3-fold increased risk of fractures.