Muscle strength decline may predict fracture risks for older adults
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A decline in physical performance can predict fracture risks independent of common risk factors such as age and bone density for older women and men, according to study findings.
“Serial measures of muscle strength and performance that can easily be performed in the office — such as sit-to-stand and gait speed — may help to identify older people at high fracture risk,” Jacqueline Center, MBBS, PhD, lab head for clinical studies and epidemiology in the bone biology division at Garvan Institute of Medical Research in Sydney, told Healio. “Among men, baseline measures of muscle strength and performance were also independently associated with fracture risk. However, lean mass obtained from DXA scans did not predict fracture risk for women or men.”
Center and colleagues analyzed data from 811 women and 440 men, all aged at least 60 years, participating in the ongoing Dubbo Osteoporosis Epidemiology Study and followed from 2000 to 2018 (mean age, 69 years; median follow-up, 10 years). Participants attended clinical visits every 2 or 3 years. Researchers measured bone mineral density at the femoral neck via DXA. Muscle strength was determined by the quadriceps strength test; physical performance was evaluated using a timed get-up-and-go test (time in seconds taken to stand from a sitting position, walk and sit back down), a sit-to-stand test repeated five times, and a gait speed test (time in seconds to finish a 6-m walking course at normal walking speed). Primary outcome was incident low-trauma fracture, assessed via X-ray.
During follow-up, 224 women and 74 men sustained at least one fracture, for an incidence rate of 30 per 1,000 person-years for women and 18 per 1,000 person-years in men. Researchers found that, apart from lean mass in women, measurements for all muscle parameters declined during follow-up.
Greater rates of decline in physical performance were associated with increased fracture risk for women. HRs for fracture were 1.29 for decline in quadricep strength score (95% CI, 0.92-1.81), 2.05 for decline in gait speed score (95% CI, 1.47-2.86), 2.65 for decline in sit-to-stand test score (95% CI, 1.92-3.64) and 2.29 for decline in timed get-up-and-go test score (95% CI, 1.66-3.14).
Among men, only decline in grip strength measurement was associated with fracture risk, with an HR of 3.4 (95% CI, 1.8-6.3).
Baseline performance and strength measurements were associated with increased fracture risk for men only, with HRs ranging from 1.81 for quadricep strength test (95% CI, 1.09-3.03) to an HR of 2.49 for the timed get-up-and-go-test (95% CI, 1.52-4.08). Results persisted after adjustments for BMI, smoking status, alcohol use, physical activity and comorbidities.
“The rates of decline in physical performance were significantly associated with a 2.3-fold increase in fracture risk in women and men,” the researchers wrote. “Baseline measurements of muscle strength and performance were also independently associated with similar magnitude of fracture risk in men. By contrast, low lean mass derived from DXA was not a predictor of increased fracture risk in either gender.”
Center said larger studies are needed to verify the results and determine whether these factors improve currently available fracture risk prediction tools.
For more information:
Jacqueline Center, MBBS, PhD, can be reached at Garvan Institute of Medical Research, 384 Victoria St., Darlinghurst NSW 2010, Australia; email: j.center@garvan.org.au.
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