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Background: Fear of falling (FoF) is common in older people. FoF in middle aged patients has been poorly studied. The effects may be more significant than they are for older people in terms of employment and personal consequences. This study asks, what is the prevalence of FoF after low trauma fragility fracture, and what effect has FoF upon employment and leisure activities?

Methods: FoF (Falls Efficacy Scale International) and activity (Nottingham Leisure Questionnaire) were assessed in patients attending fracture clinic of a large UK Trust, referred by the medical team for further investigations of bone health. Patients where the fracture was greater than 3 months were excluded.

Results: Mean levels of FoF after fracture were 31.67 (SD 10.96). In those aged ≤ 65 (n = 26) and ≥66 (n = 59) mean FES-I was 31.08 (SD 10.34) and 31.93 (SD 11.31) respectively (p > 0.05). High FOF (FES-I >23) was reported by 73% of those aged ≤ 65 years, and 73% in those aged ≥66 years.

Pre-fracture activity levels were significantly higher than those reported after fracture [mean 33.38, SD 7.60 as compared to 17.45, SD 5.32); p < 0.05. In those aged ≤ 65 and ≥66 the mean NLQ pre-fracture was 30.69, SD 6.42 and 34.56, SD 7.83 respectively (p < 0.05). Post-fracture mean NLQ activity levels were 15.46, SD 5.69 and 18.32, SD 4.95 (p< 0.05).

Discussion: There is a high prevalence of FoF after low trauma fragility fracture, which is associated with decreased activity levels. In middle aged people this high prevalence may impact employment performance in addition to leisure activities. Given its prevalence and importance, questions to assess FOF should be incorporated into the clinical assessment of middle aged adults after fragility fracture. Interventions must be sourced and targeted to this under researched population that may curb loss of employment and quality of life.

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