Oral Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Frailty is associated with greater long-term risk for fall and fracture-related hospitalisations as well as mortality in community-dwelling older Australian women (#40)

Marc Sim 1 2 , Elsa Dent 3 , Jack DallaVia 2 , Trent Bozanich 2 , Emiel o Hoogendijk 4 , Gebre Abadi 2 , Smith Cassandra 2 , Prince L Richard 1 , Joshua R Lewis 1 2
  1. Medical School, The University Western Australia, Perth, Western Australia, Australia
  2. Nutrition & Health Innovation Research Institute, Edith Cowan University, joondalup, WA, Australia
  3. Torrens University Australia, Adelaide, SA, Australia
  4. VU University Medical Center, Amersterdam, The Netherlands

Introduction: Frailty is associated with declines in physiological capacity across sensory, neurological and musculoskeletal systems with the underlying assumption being the frailer an individual is, the more likely they are to fall and fracture. We examined whether grades of frailty can assess the long-term risk of hospitalised falls, fractures and all-cause mortality in 1261 community-dwelling older women (75.1 ± 2.7 years) over 14.5 years.

Methods: Frailty was operationalised using a frailty index (FI) of cumulative deficits from 33 variables across multiple health domains (physical, mental, comorbidities) at baseline. The total score across these variables were summed and divided by 33 to obtain the FI. Participants were graded as either fit (FI ≤0.12), mildly frail (FI >0.12-0.24), moderately frail (FI >0.24-0.36) or severely frail (FI >0.36). Fall- (n=498), any fracture- (n=347) and hip fracture-related hospitalisations (n=137) and deaths (n=482) were obtained from linked health records over 14.5 years. Associations between FI grades and each of the clinical outcomes were analysed using multivariable-adjusted Cox-proportional hazard models including age, treatment (calcium/placebo), body mass index, smoking history, socioeconomic status, plasma 25-hydroxyvitamin D status plus season obtained, physical activity, self-reported prevalent falls and fractures.

Results: At baseline, 713 (56.5%),  350 (27.8%), 163 (12.9%) and 35 (2.8%) of women were classified as fit, mildly- moderately- and severely-frail, respectively. Women with mild, moderate and severe frailty had significantly higher hazards for a fall- (46%, 104%, 168%), any fracture- (88% for moderate frailty, 193% for severe frailty), hip fracture-related hospitalisation (93%, 127%, 129%) and all-cause mortality (47%, 126%, 242%) (Figure). When hip BMD was included as an additional covariate, results remained unchanged.

Conclusion: The FI identified community-dwelling older women at risk for the most serious falls and fractures, and may be incorporated into relevant risk assessment tools to identify individuals with poorer clinical prognosis.

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