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. 2024 Jan 2;7(1):e2352675.
doi: 10.1001/jamanetworkopen.2023.52675.

Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Dana Bliuc  1   2   3 , Thach Tran  1   4 , Dunia Alarkawi  1   4 , Weiwen Chen  1 , Dima A Alajlouni  1   4 , Fiona Blyth  5 , Lyn March  6 , Robert D Blank  1 , Jacqueline R Center  1   4
Affiliations

Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Dana Bliuc et al. JAMA Netw Open. .

Erratum in

  • Error in Figure.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Feb 5;7(2):e242957. doi: 10.1001/jamanetworkopen.2024.2957. JAMA Netw Open. 2024. PMID: 38373002 Free PMC article. No abstract available.

Abstract

Importance: The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated.

Objective: To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture.

Design, setting, and participants: This prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023.

Exposure: Self-reported walking limitation.

Main outcomes and measures: Incident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures).

Results: Among the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase.

Conclusions and relevance: In this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chen reported giving educational talks for Amgen outside the submitted work. Dr March reported receiving grants from Osteoporosis Australia during the conduct of the study. Dr Blank reported serving as a consultant for Guidepoint and Bristol-Myers Squibb; serving on the advisory board of Amgen; receiving royalties from Wolters Kluwer; receiving an editorial stipend from Elsevier; receiving travel support from Amgen; serving on the board of directors for the International Federation of Musculoskeletal Research Societies and the International Society for Clinical Densitometry; and owning stock in Abbott Labs, Abbvie, Amgen, JangoBio, and Procter & Gamble. Dr Center reported serving on the advisory board of Amgen and giving educational talks for Amgen and Teva. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Study Participants
Figure 2.
Figure 2.. Heuristic Population Attributable Risk for Limited Mobility, Age, Weight, and History of Fracture and Falls
aWeight was defined as 50 kg or less for women and 70 kg or less for men.
Figure 3.
Figure 3.. Forest Plot of Sex-Specific Hazard Ratios (HRs) Comparing the Risk of Different Fracture Sites According to Ability to Walk 1000 m
See this image and copyright information in PMC

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