A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos)

Kennedy, Courtney; Ioannidis, George; Rockwood, Kenneth; Thabane, Lehana; Adachi, Jonathan D.; Kirkland, Susan; Pickard, Laura; Παπαϊωάννου, Αλεξάνδρα

doi:10.1007/s00198-014-2828-9

Cited by 77 publications

(78 citation statements)

References 35 publications

(64 reference statements)

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“…Few studies have examined the demographics of frailty in LTC, although a high prevalence is reported for both men and women [22,23]. In contrast, we have found that among community dwellers, women are frailer than men across all age decades [2].…”

Section: Discussioncontrasting

confidence: 52%

“…Given that there is a strong relationship between frailty and fractures that is independent of age [2], these residents are at high risk for fractures due to frailty-related risk factors. Residents of LTC who had a fracture while living in the community have been found to be at greater risk of both entering LTC [9] and having a future hip fracture [18,21].…”

Section: Discussionmentioning

confidence: 99%

“…With aging comes a gradual and progressive decline in bone quantity and quality and an increase in frailty, with a corresponding increase in fracture risk [1,2]. The risk of a first [3] and subsequent [4][5][6] osteoporotic fracture increases with age.…”

Section: Introductionmentioning

confidence: 99%

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Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

et al. 2016

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Summary-In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women.Introduction-This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

et al. 2016

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“…Although the idea and approach are relatively simple, the results yielded by the FI have been consistent across many settings, even though not every FI considers the same deficits, or even the same number of deficits 10, 18, 19. The prognostic implications of FI have been demonstrated not only in a variety of different chronic conditions (osteoporosis,20 human immunodeficiency virus and AIDS,21 kidney disease22) but also in acute disease states (trauma23). …”

Section: Discussionmentioning

confidence: 94%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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“…The FI could grade and predict the risk of fractures based on the degree of frailty in the elderly, which had been explored in previous studies [23][24][25][26]. However, limited evidence comparing the predictive accuracy of the FI and FRAX in the risk of fractures is available.…”

Section: Introductionmentioning

confidence: 96%

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures

Thabane

Παπαϊωάννου

et al. 2015

Bone

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A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that measures of frailty status may aid in fracture risk assessment and fracture prevention in the elderly. Further evidence from randomized controlled trials of osteoporosis medication interventions is needed to support the FI and FRAX as validated measures of fracture risk.

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A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos)

Cited by 77 publications

References 35 publications

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures

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