Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures

Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, and Department of Medicine, University of Minnesota, Minneapolis, MN 55417, USA.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences (Impact Factor: 5.42). 07/2007; 62(7):744-51. DOI: 10.1093/gerona/62.7.744
Source: PubMed


A standard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults. However, the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain.
To determine whether a standard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index (BMI), we ascertained frailty status in a cohort of 6724 women>or=69 years and followed them prospectively for incident falls, fractures, and mortality. Frailty was defined by the presence of three or more of the following criteria: unintentional weight loss, weakness, self-reported poor energy, slow walking speed, and low physical activity. Incident recurrent falls were defined as at least two falls during the subsequent year. Incident fractures (confirmed with x-ray reports), including hip fractures, and deaths were ascertained during an average of 9 years of follow-up.
After controlling for multiple confounders such as age, health status, medical conditions, functional status, depressive symptoms, cognitive function, and bone mineral density, frail women were subsequently at increased risk of recurrent falls (multivariate odds ratio=1.38, 95% confidence interval [CI], 1.02-1.88), hip fracture (multivariate hazards ratio [MHR]=1.40, 95% CI, 1.03-1.90), any nonspine fracture (MHR=1.25, 95% CI, 1.05-1.49), and death (MHR=1.82, 95% CI, 1.56-2.13). The associations between frailty and these outcomes persisted among women>or=80 years. In addition, associations between frailty and an increased risk of falls, fracture, and mortality were consistently observed across categories of BMI, including BMI>or=30 kg/m2.
Frailty is an independent predictor of adverse health outcomes in older women, including very elderly women and older obese women.

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    • "E.g., up to 12% of all falls in the elderly are followed by a fracture, and 23% of trauma-related deaths in patients >65 years and 34% in those >85 years follow a fall [11,13]. The relationship among frailty and falls has been investigated in some studies based on the frailty phenotypic model and its variants [14-17], but few have studied the relationship using the continuous FI. More evidence regarding the relationship between frailty and falls with the use of a FI will be helpful at a clinical research level and at a health care policy level [7]. "
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    ABSTRACT: Background To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older. Methods The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N = 3,985) aged ≥55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined. Results The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively. Conclusion The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly.
    Full-text · Article · May 2014 · BMC Musculoskeletal Disorders
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    • " the frail group (52%) and low for the nonfrail group (17%). These findings suggest that fall-related injuries can present a serious health issue for frail elderly people. de Vries, Peeters, Lips, and Deeg (2013) highlighted that frailty is significantly correlated with time to second fall and associated with greater than or equal to two fractures.Ensrud et al. (2007)compared the age-adjusted risk for hip fractures between robust women and frail women.Bilotta et al. (2012)asserted that frailty in elderly people is associated with greater risk of adverse outcomes and a high age-adjusted risk for recurrent falls, disability, nonspinal fractures, and death. Therefore, the concept of frailty is associate"
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    ABSTRACT: This study explored the risk factors, cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values of physical performance testing among community-dwelling frail elderly people in Taiwan. The empirical measurement of frailty is based on the following five indicators: weight loss, weakness, exhaustion, slow responses, and minimal physical activity. The frail phenotype is considered present if three or more of the indicators are observed. Meanwhile, a short battery of physical performance tests was conducted to assess the balance, mobility, and flexibility among elderly people. A cross-sectional research design was executed. Participants were evaluated using a short battery of physical performance tests to assess their physical performance. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed. The logistic regression results showed that the factors significantly correlated to frailty included falls in the previous year, smoking, hypertension, and bone and joint disease. Physical performance test scores were analyzed using the ROC curves to discriminate frailty statuses. The analysis results showed that the areas under the ROC curves for the diagnostic accuracy of right-hand grip, left-hand grip, and the 8-foot up-and-go test reached 0.70, and the optimal cut-off points determined using Youden's index were 17.25 kg, 20.75 kg, and 8.13 s, respectively. The research findings suggest that physical performance variables can be used to effectively screen elderly people at risk for frailty in the community. The findings offer reference values for physical performance tests specific to community-dwelling frail elderly people. The information can enable health practitioners to achieve early identification of frailty among elderly people with anthropometric characteristics similar to those associated with people in Asian countries.
    Full-text · Article · Feb 2014 · Journal of Nursing Scholarship
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    • "People with three or more criteria are considered frail and those with one to two are considered intermediate or prefrail. The model has been adapted for use across many ageing cohort studies.6364656667 A pared down version incorporating weight loss, exhaustion and impaired chair rising has also been proposed by the Study of Osteoporotic Fractures (SOF) group.4959 "
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    ABSTRACT: Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well-tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs) suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.
    Full-text · Article · Jan 2014 · Asian Journal of Andrology
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