Alcohol use is common in older patients with fall-related fractures: a secondary analysis from a prospective cohort study using PEth as an objective assessment of consumption

BACKGROUND AND PURPOSE: Alcohol increases the risk of falls and complications, but data on alcohol intake among trauma patients is unreliable. Excessive alcohol use can contribute to excess frailty and confusion in frail individuals and increase fall risk in otherwise robust older people. Phosphatidylethanol (PEth) is a biomarker accumulating through repeated alcohol intake, i.e., suitable for screening long-term consumption. Our primary aim was to describe alcohol consumption in older individuals admitted after a fall-related fracture. Our secondary, exploratory aims were to investigate the association between alcohol, frailty, and short-term clinical outcomes in these individuals. METHODS: This prospective observational cohort study included those ≥ 65 years admitted due to acute fall-related fracture February 1, 2023-August 31, 2024. PEth was taken at admission. Predefined norm values classified low/no consumption as < 0.05, intermediate 0.05-0.30 and hazardous consumption > 0.30 µmol/L. Frailty status was assessed by the Clinical Frailty Scale (CFS). Our secondary aim was addressed using multivariable logistic regression on a propensity score-matched cohort. RESULTS: Of the 505 patients included, 13% had PEth indicating hazardous consumption, 8.9% intermediate consumption, and 78% had low/no consumption. Of the non-frail patients, 18% had hazardous and 11% intermediate consumption. 19% of all women and 29% of all men had continuous alcohol consumption (defined as PEth ≥ 0.05 µmol/L). In the matched cohort, alcohol consumption was associated with a higher odds ratio (OR) of hyponatremia (OR 2.3, 95% confidence interval [CI] 1.1-4.5, P = 0.02). A trend towards lower odds of 90-day mortality (OR 0.2, CI 0.1-1.0, P = 0.05) was seen. CONCLUSION: A minimum of 1/5 older patients with fall-related fractures have continuous alcohol consumption. Non-frail patients had a higher intake than frail individuals. Alcohol consumption was associated with higher odds of hyponatremia. Otherwise, no apparent negative effects were identified in the short term.