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. 2021 Sep;32(9):1735-1744.
doi: 10.1007/s00198-021-05886-7. Epub 2021 Mar 4.

In community-dwelling women frailty is associated with imminent risk of osteoporotic fractures

P Bartosch  1   2 , L Malmgren  1   2   3 , J Kristensson  4   5 , F E McGuigan  1   2 , K E Akesson  6   7
Affiliations

In community-dwelling women frailty is associated with imminent risk of osteoporotic fractures

P Bartosch et al. Osteoporos Int. 2021 Sep.

Abstract

Frailty reflects an accelerated health decline. Frailty is a consequence of fracture and contributes to fracture. Greater frailty was associated with higher fracture risk. Frail women were at immediate risk (within 24 months) of a hip or major fracture. Fracture prevention could be improved by considering frailty status.

Introduction: Frailty encompasses the functional decline in multiple systems, particularly the musculoskeletal system. Frailty can be a consequence of and contribute to fracture, leading to a cycle of further fractures and greater frailty. This study investigates this association, specifically time frames for risk, associated fracture types, and how grade of frailty affects risk.

Methods: The study is performed in the OPRA cohort of 1044, 75-year-old women. A frailty index was created at baseline and 5 and 10 years. Women were categorized as frail or nonfrail and in quartiles (Q1 least frail; Q4 most frail). Fracture risk was assessed over short (1 and 2 years) and long terms (5 and 10 years). Fracture risk was defined for any fracture, major osteoporotic fractures (MOFs), and hip and vertebral fracture, using models including bone mineral density (BMD) and death as a competing risk.

Results: For women aged 75, frailty was associated with higher risk of fracture within 2 years (Hip SHRadj. 3.16 (1.34-7.47)) and MOF (2 years SHRadj. 1.88 (1.12-3.16)). The increased risk continued for up to 5 years (Hip SHRadj. 2.02 (1.07-3.82)); (MOF SHRadj. 1.43 (0.99-2.05)). Grade of frailty was associated with increased 10-year probability of fracture (p = 0.03). Frailty predicted fracture independently of BMD. For women aged 80, frailty was similarly associated with fracture.

Conclusion: Frail elderly women are at immediate risk of fracture, regardless of bone density and continue to be at risk over subsequent years compared to identically aged nonfrail women. Incorporating regular frailty assessment into fracture management could improve identification of women at high fracture risk.

Keywords: BMD; Community dwelling; Fracture; Frailty; Women.

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Conflict of interest statement

The authors Patrik Bartosch, Linnea Malmgren, Jimmie Kristensson, Fiona McGuigan, and Kristina Åkesson declare no potential conflicts of interest according to ICMJE requirements with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
Cumulative incidence of any fracture stratified by frailty status at a age 75 and b age 80, calculated in the presence of the competing risk of death. Differences in cumulative incidence rates between frail and nonfrail categories were tested using Gray’s test
Fig. 2
Fig. 2
Cumulative incidence of a any fracture and b hip fracture, stratified by quartiles of frailty at age 75, calculated in the presence of the competing risk of death. Differences in cumulative incidence rates between Q1 and Q4 was tested using Gray’s test. The graphs show that among the least frail (Q1), fracture accumulation occurs between 2.5 (any fracture) and 4.7 years (hip fracture) later, i.e., they remain fracture free for longer compared to the most frail women (Q4). *Frailty quartiles Q1 (≤ 0.11), Q2 (0.12–0.16), Q3 (0.17-0.24), and Q4 (≥ 25)
Fig. 3
Fig. 3
Flowchart demonstrating how frailty score is affected by having had a fracture (at least one fracture of any type). At baseline, women were stratified based on whether they had at least one previous fracture between 50 and 75. Frailty score at 5- and 10-year visits is shown, based on fracture history during the intervening period. *FIs are population mean. The calculations were made on women that attended all follow-ups
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