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.
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.
The Journal of urology. 2019 Jul 26 [Epub ahead of print]
Jori S Pesonen, Robin W M Vernooij, Rufus Cartwright, Yoshitaka Aoki, Arnav Agarwal, Altaf Mangera, Alayne D Markland, Johnson F Tsui, Henrikki Santti, Tomas L Griebling, Alexey E Pryalukhin, Jarno Riikonen, Riikka M Tähtinen, Camille P Vaughan, Theodore M Johnson, Diane Heels-Ansdell, Gordon H Guyatt, Kari A O Tikkinen
Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland., Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands., Department of Epidemiology and Biostatistics, Imperial College, London, UK., Department of Urology, University of Fukui, Fukui, Japan., Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK., Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama-Birmingham UAB School of Medicine, Birmingham, Alabama, USA., Department of Urology, Hackensack University Medical Center, New Jersey, New York, USA., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Urology and The Landon Center On Aging, University of Kansas, Kansas City, Kansas, USA., Department of Urology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia., Department of Urology, Tampere University Hospital, and Faculty of Medicine and Life Science, University of Tampere, Tampere, Finland., Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland., Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia, USA., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.