People over 70 who take a daily low dose of aspirin are more likely to have a serious fall, according to recent findings that may support more cautious prescribing when issuing the drug to people with a heightened risk of heart attacks and strokes.
Aspirin’s blood-thinning properties mean it is often prescribed to prevent cardiovascular complications. Research also suggests the drug may somewhat slow cognitive decline and strengthen bones, a combination that would theoretically lead to fewer serious falls.
But results from the Aspirin in Reducing Events in the Elderly (ASPREE) trial contradict that idea, with the most recent findings pointing towards an increase in severe falls when older people take a low dose of aspirin every day, reports the New Scientist.
The findings, published in JAMA Internal Medicine, describe how, for an average of 4.6 years, Anna Barker at Monash University in Melbourne, Australia, and her colleagues, followed 16 703 white Australian people aged 70 or over, all “relatively healthy”.
Half of them were assigned 100mg of aspirin, a dose commonly prescribed to older people for the long term, to take once a day. The remainder had a placebo. Some of the participants took medication for other conditions, with this drug use being balanced between the aspirin and placebo groups.
During the study period, more than 1 400 of the participants had at least one fall that required hospital care, says Barker.
People in the aspirin group were just under 10% more likely to have such a fall, compared with those not taking aspirin. A statistical analysis suggests this wasn’t a chance finding.
There was no significant difference in fracture risk between the two groups. It is unclear whether the same results apply to people of non-white ethnicities.
“We need to weigh up the risks and benefits with every medication we add into the regime for an older person, and definitely – in terms of primary prevention without indication of cardiovascular or stroke risk – we’d need to be very dubious about prescribing aspirin, knowing the increased risks that it brings with relation to serious falls,” says Barker.
This is a high-quality study that addresses an important question around the potential of regularly taking low-dose aspirin to reduce falls and fractures, says Jennifer Burns at the British Geriatrics Society. About half of people over 80 fall at least once a year, so understanding risk factors is critical, she says.
The increase in serious falls in the aspirin group may be related to the drug’s anticoagulant effect, says Burns. People who fall while taking aspirin may have considerable bleeding or bruising, prompting emergency care. Bleeding and bruising weren’t assessed in the study.
Exercises to improve balance and fitness may more effectively reduce falls as people age, says Burns.
Study details
Daily Low-Dose Aspirin and Risk of Serious Falls and Fractures in Healthy Older People: A Sub-study of the ASPREE Randomised Clinical Trial
Anna L. Barker, Renata Morello, Le Thi Phuong Thao, et al
Key Points
Question Does daily low-dose aspirin reduce fractures and serious falls in healthy older people?
Findings In this sub-study of a randomised placebo-controlled trial, the risk of first fracture was similar in the aspirin and placebo groups, but the risk of serious fall was statistically significantly greater in the aspirin group (total falls 884 vs 804).
Meaning The findings indicate a potential additional risk for the use of low-dose aspirin in older people.
Abstract
Importance
Falls and fractures are frequent and deleterious to the health of older people. Aspirin has been reported to reduce bone fragility and slow bone loss.
Objective
To determine if daily low-dose aspirin (100mg) reduces the risk of fractures or serious falls (fall-related hospital presentations) in healthy older men and women.
Design, Setting, and Participants
This sub-study of a double-blind, randomised, placebo-controlled trial studied older adult men and women in 16 major sites across south-eastern Australia. The ASPREE-FRACTURE sub-study was conducted as part of the Australian component of the ASPREE trial. Between 2010 and 2014 healthy (free of cardiovascular disease, dementia or physical disability), community-dwelling volunteers aged 70 or older were recruited to participate in the ASPREE trial. Potentially eligible participants were identified by medical practitioners and trial personnel and were then sent a letter of invitation to participate. Interested participants were screened for suitability. Eligible participants with medical practitioner authorisation and adherent to a four-week run-in medication trial were randomized. Data were analysed from October 17, 2019, to August 31, 2022.
Interventions
Participants in the intervention group received a daily dose of oral 100mg enteric-coated (low-dose) aspirin. The control group received a daily identical enteric-coated placebo tablet.
Main Outcomes and Measures
The primary outcome of ASPREE-FRACTURE was the occurrence of any fracture. The secondary outcome was serious fall resulting in hospital presentation.
Results
In total, 16 703 people with a median (IQR) age of 74 (72-78) years were recruited, and 9 179 (55.0%) were women. There were 8 322 intervention participants and 8 381 control participants included in the primary and secondary outcome analysis of 2 865 fractures and 1 688 serious falls over the median follow-up of 4.6 years. While there was no difference in the risk of first fracture between the intervention and control participants (hazard ratio, 0.97; 95% CI, 0.87-1.06; P = .50), aspirin was associated with a higher risk of serious falls (total falls 884 vs 804; incidence rate ratio, 1.17; 95% CI, 1.03-1.33; P = .01). Results remained unchanged in analyses that adjusted for covariates known to influence fracture and fall risk.
Conclusions and relevance
In this sub-study of a randomised 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 favourable benefit in a healthy, white older adult population.
JAMA Internal Medicine article
See more from MedicalBrief archives:
Aspirin reduces cardiovascular events in elderly with raised Lp(a) – ASPREE analysis
Moderate alcohol use associated with lower CVD risk and all-cause mortality – ASPREE
Large trial produces ‘best evidence’ of aspirin benefits in reducing CVD risk
Aspirin risk in patients without cardiovascular disease — trials review