Association Between Fear of Falling and Functional Impairment in Patients With Osteoporosis: A Systematic Review and Meta‐Regression Analysis

ABSTRACT Objectives To systematically evaluate the association between fear of falling (FOF) and functional impairment in patients with osteoporosis and to explore potential moderators using meta‐regression analysis. Design A systematic review and meta‐regression analysis was conducted. Data sources PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to June 2025. Eligibility criteria observational studies involving adults with osteoporosis that quantitatively assessed fear of falling and functional impairment were included. Data Extraction and Synthesis Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random‐effects meta‐analysis was conducted to pool effect estimates. Heterogeneity was quantified using the I 2 statistic. Meta‐regression analyses were performed to identify potential sources of heterogeneity. Results A total of 18 studies comprising 6243 participants were included. Higher levels of fear of falling were significantly associated with increased odds of functional impairment (pooled OR 2.12, 95% CI 1.72 to 2.61; I 2 = 68%). Meta‐regression suggested that mean age, proportion of female participants, and history of osteoporotic fracture significantly moderated the association. Conclusions Fear of falling is strongly associated with functional impairment in patients with osteoporosis. These findings highlight the importance of incorporating psychological assessment and targeted interventions for fear of falling into osteoporosis management.