Low-Dose Aspirin Increases Risk of Falls in Older Adults

Daily intake of low-dose aspirin among older, healthy adults may increase the risk for serious falls but had no impact on the risk of first fracture, according to a sub-study of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial. 

Included in this sub-study (named ASPREE-FRACTURE) were 16,703 participants of the ASPREE study who were recruited from 16 major sites across southeastern Australia. The authors recruited to participate community-dwelling volunteers who were 70 years of age or older without cardiovascular disease, dementia, or physical disability.

The primary outcome was occurrence of any fracture, and the secondary outcome was a serious fall which resulted in hospital presentation. A total of 8322 participants were randomized to receive a daily dose of oral 100 mg enteric-coated low-dose aspirin and 8381 participants received a placebo for 4 weeks. Over a median follow-up of 4.6 years, a total of 2865 fractures and 1688 serious falls were reported.

The results indicated that the use of aspirin was associated with a higher risk of falls, with 884 falls in the intervention group and 804 in the control group (1.17 incidence rate ratio; 95% CI, 1.03 – 1.33, p = .01). This result was despite adjusting for covariates known to impact fracture and fall risk. Further, the results indicated there was no difference in the risk of first fracture between groups (HR 0.97; 95% CI, 0.87 – 1.06, p =.50).

Limitations of the study include a lack of individuals at risk of osteoporosis or in racial/ethnic minority groups, and the length and dose of intervention may not have been sufficient to allow for the development of any meaningful changes to fracture or falls risks. Bone density and other bone quality indicators were not measured.

“In this sub-study of a randomized clinical trial, the failure of low-dose aspirin to reduce the risk of fractures while increasing the risk of serious falls adds to evidence that this agent provides little favorable benefit in a healthy, White older adult population,” the researchers concluded. 

Reference:

Barker AL, Morello R, Thao LTP, et al. Daily low-dose aspirin and risk of serious falls and fractures in healthy older people: a sub-study of the ASPREE randomized clinical trial. JAMA Intern Med. 2022;182(12):1289-1297. doi:10.1001/jamainternmed.2022.5028