Frailty and Fracture, Disability, and Falls: A Multiple Country Study From the Global Longitudinal Study of Osteoporosis in Women

Abstract

Objectives To test whether women age ≥ 55 years with increasing evidence of a frailty phenotype would have greater risk of fractures, disability, and recurrent falls, compared with women who were not frail, across geographic areas (Australia, Europe, and North America) and age groups. Design Multinational, longitudinal, observational cohort study. Setting The Global Longitudinal Study of Osteoporosis in Women (GLOW). Participants Women (n=48,636) age ≥ 55 years enrolled at sites in Australia, Europe, and North America. Measurements Components of frailty (slowness/weakness, poor endurance/exhaustion, physical activity, and unintentional weight loss) at baseline and report of fracture, disability, and recurrent falls at 1 year of follow-up were investigated. Women also reported health and demographic characteristics at baseline. Results Among those age < 75 years, women from the United States were more likely to be prefrail and frail than women from Australia/Canada, and Europe. The distribution of frailty was similar by region for women age ≥ 75 years. Odds ratios from multivariable models for frailty versus non frailty were 1.23 (95% CI = 1.07–1.42) for fracture, 2.29 (95% CI = 2.09–2.51) for disability, and 1.68 (95% CI = 1.54–1.83) for recurrent falls. The associations for pre-frailty versus non frailty were weaker but still indicated statistically significant increased risk for each outcome. Overall, associations between frailty status and each outcome were similar across age and geographic region. Conclusion Increased evidence of a frailty phenotype is associated with increased risk for fracture, disability, and falls among women age ≥ 55 years in 10 countries, with similar patterns across age and geographic region.

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

“…Previous studies that have established a link between frailty and fractures have utilized measures which categorize individuals into discrete categories (i.e., frail/pre-frail/nonfrail) [9][10][11][12]14]. In cohorts which utilized the frailty phenotype [5,9,12,14] or a simplified version [10,11], individuals classified as frail versus nonfrail had greater risk of incident hip and/or nonvertebral fractures.…”

“…In cohorts which utilized the frailty phenotype [5,9,12,14] or a simplified version [10,11], individuals classified as frail versus nonfrail had greater risk of incident hip and/or nonvertebral fractures. In contrast, a study which utilized a nine-item measure similar to the frailty phenotype did not find a significant association between frailty/nonfrailty status and fractures [15].…”

“…Frailty has been linked with increased fracture risk in older adults [9][10][11][12][13][14]. However, previous studies have largely assessed frailty utilizing the frailty phenotype [12,14] or modified versions [9][10][11]15], all of which categorize individuals into discrete frail/nonfrail categories.…”

“…However, previous studies have largely assessed frailty utilizing the frailty phenotype [12,14] or modified versions [9][10][11]15], all of which categorize individuals into discrete frail/nonfrail categories. A Frailty Index allows the quantification of risk according to the degree of frailty.…”

Clinical and surgical complexity in severe osteoporosis

“…The management of the patient with severe osteoporosis is complicated by his/ her multimorbidity (about 50 % of the over 65 aged people takes more than 5 different drugs daily) [5] making both pharmacological and surgical approaches more challenging. For example, individuals with hip fracture are typically complex patients, with coexisting comorbidities, disability and frailty [6]. A study investigating the effect of comorbidities on mortality after hip fracture showed that in elderly people, the presence of 3 or more comorbidities was the strongest preoperative risk factor [7].…”