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Frailty predicts fracture risk in older adults
In older adults, frailty and even “prefrailty” is a predictor of future fractures, according to a recent meta-analysis.
Gotaro Kojima, MD, of Japan Green Medical Centre in London, analyzed data from six prospective cohort studies examining associations between frailty and subsequent fracture risk published since 2000 (n = 96,564; mean age, 76 years) and conducted in the United States (n = 3), the Netherlands (n = 1), Italy (n = 1) and multiple countries (n = 1). Studies included community-dwelling older adults (three studies included only women) who were longitudinally examined for risk for any fracture according to baseline frailty and validated in population-based studies. Four studies used modified versions of the Cardiovascular Health Study to characterize frailty, which was defined as having three or more of five criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. One study used the Longitudinal Aging Study Amsterdam frailty instrument; one used the Coselice Study of Brain Aging frailty index. Studies that defined frailty by disabilities, morbidities or walking speed were excluded.
Researchers found that frailty was associated with 70% increased odds of fracture risk (pooled OR = 1.7; 95% CI, 1.34-2.15). Prefrailty also was associated with higher fracture risk (pooled OR = 1.31; 95% CI, 1.18-1.46).
In four studies where HRs for frailty and fractures were available, researchers found an association with frailty and higher risk for fractures (pooled HR = 1.57; 95% CI, 1.31-1.89). Researchers also found an association in the three studies that included HRs for prefrailty and fractures (pooled HR = 1.3; 95% CI, 1.12-1.51). In meta-regression analysis, study location was found to be a risk modulator, with studies conducted in the United States showing a higher OR for fractures vs. non-U.S. studies (regression coefficient = 0.39 for U.S. studies). Researchers speculated that the disparity could be due to study design because U.S. studies were designed for fracture and employed frequent fracture monitoring systems at 4-month intervals.
“The exact mechanisms underlying the association between frailty and a higher risk of fracture are not clear,” the researchers wrote. “Considering multidimensional features of frailty and multiple risk factors for falling, the association may be complex and multifactorial. Since falls are one of the common causes of fracture, a higher fracture risk may be attributed to a higher risk of falls according to frailty. Multiple studies have shown that fall frequency and characteristics were more strongly correlated with fractures than bone mineral density.”
Weight loss could be another possible explanation, the researchers noted, as weight loss is a main component used to conceptualize frailty in the Cardiovascular Health Study and other criteria. – by Regina Schaffer
Disclosure: Kojima reports no relevant financial disclosures.
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