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.
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.
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.