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. 2026 Feb;17(1):117-127.
doi: 10.1007/s41999-025-01364-z. Epub 2025 Nov 28.

Arm circumference predicts 12-month mortality in older adults with hip fracture

Chiara Ceolin  1   2   3 , Giulia Termini  1   2 , Stefania Sella  1   4 , Valentina Camozzi  5 , Anna Bertocco  2 , Marco Onofrio Torres  1   4 , Alberta Cecchinato  1   4 , Martin Diogo  1   4 , Mor Peleg Falb  1   4 , Francesca Guidolin  1   4 , Maria Grazia Rodà  6 , Michele Cannito  5 , Antonio Berizzi  7 , Andrea Venturin  8 , Vito Cianci  9 , Elisa Pala  6 , Mariachiara Cerchiaro  6 , Deris Gianni Boemo  10 , Maria Vittoria Nesoti  10 , Gaetano Paride Arcidiacono  11   12 , Paolo Simioni  1   4 , Pietro Ruggieri  6 , Giuseppe Sergi  1   2 , Sandro Giannini  1   4 , Marina De Rui  2 ; Hip-POS Working Group
Collaborators, Affiliations

Arm circumference predicts 12-month mortality in older adults with hip fracture

Chiara Ceolin et al. Eur Geriatr Med. 2026 Feb.

Abstract

Purpose: Hip fractures (HF) in older adults are a major public health issue due to their high incidence and association with mortality and long-term disability. Simple bedside measures reflecting nutritional and muscular status-such as handgrip strength (HGS), arm circumference, and calf circumference-may help identify patients at higher risk of adverse outcomes. This study compared the predictive value of these parameters for 1-year mortality in older adults hospitalized for hip fracture.

Methods: We conducted a retrospective study on 295 patients aged ≥65 years admitted for fragility HF at the Azienda Ospedale-Università Padova. Demographic, clinical, and anthropometric data were collected at admission, along with a comprehensive geriatric assessment. Twelve-month mortality was the primary outcome. Prognostic value was assessed using ROC curves, Kaplan-Meier analysis, and multivariable Cox regression.

Results: At 12 months, mortality was higher among patients with low arm (27.1%) and calf circumference (28.8%) (p = 0.008 and p = 0.010), while no difference was observed for HGS. ROC curve analysis showed that arm (AUC = 0.704, p < 0.001) and calf circumference (AUC = 0.634, p = 0.006) were associated with mortality, unlike HGS (p = 0.307). Kaplan-Meier survival analysis confirmed lower survival in patients with arm and calf circumference under 20th percentile, defined, respectively, low arm and calf (log-rank p = 0.003 and p = 0.02, respectively). In Cox models, low arm circumference remained independently associated with mortality across all adjustments (HR = 2.86; 95% CI 1.45-5.64; p = 0.002), whereas the association for calf circumference lost significance.

Conclusion: Arm circumference is a simple, cost-effective, and reliable bedside tool to help identify older adults at increased risk of mortality after HF.

Keywords: Arm circumference; Fracture liaison service; Fragility hip fractures; Handgrip strength.

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Conflict of interest statement

Declarations. Conflict of interest: All authors have no competing interests to declare that are relevant to the content of this article. Human and animal rights statement and ethics approval: The study was performed in accordance with the 1964 Helsinki declaration and its later amendments. The study was authorized by the local Ethics Committee (Comitato Etico Territoriale Area Centro-Est Veneto, 442n/AO/23). The committee provided ethical approval for the research protocol, ensuring that the study complies with the ethical standards for research involving human participants. Informed consent: Written informed consent was obtained for all study participants; in case of impossibility to sign the informed consent, such as in severely ill patients or patients with dementia, informed consent was signed by patient’s legal guardian.

Figures

Fig. 1
Fig. 1
Comparison of arm circumference, calf circumference, and handgrip strength for predicting 12-month mortality: a ROC curve analysis
Fig. 2
Fig. 2
Kaplan–Meier curves stratified according to the 20th percentile of arm (a) and calf (b) circumferences
See this image and copyright information in PMC

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