Abstract

BackgroundFrailty is characterised by age-related declines in physical, psychological and social functioning. Features of frailty overlap with risk factors for fragility fractures. The aim of this study was to investigate the association between the fracture risk assessment tool (FRAX®) and frailty.MethodsIn cross-sectional analysis, frailty status was determined for participants aged 60-90 yr at 15-year follow-up of the Geelong Osteoporosis Study, using a modified Fried frailty phenotype. Using the FRAX on-line tool, scores for hip and major osteoporotic fracture (MOF) were calculated with and without bone mineral density (BMD). Using the area under Receiver Operating Characteristic (AUROC) curves, and FRAX scores calculated at the baseline visit for these participants, we investigated the association of FRAX and frailty 15 years later.ResultsForty-seven of 303 women (15.5%) and 41 of 282 men (14.5%) were frail at the 15-year visit. There was a gradient of increasing median FRAX scores from robust to frail. For example, for women, median MOF-FRAX without BMD increased from 5.9 for the robust to 7.5 for the pre-frail and 14.0 for the frail (p < 0.001). In secondary analyses, an association was observed between FRAX and frailty over 15 years, with the highest AUROC for women being 0.72 for MOF-FRAX with BMD, and for men, 0.76 hip-FRAX without BMD.ConclusionAn association was observed between FRAX and frailty where frail men and women had higher FRAX-scores compared to the other groups. Preliminary data suggest that FRAX, with or without BMD, may be useful in enhancing the information on frailty. Further research using larger datasets will be required to explore this.

Highlights

  • Frailty is characterised by age-related declines in physical, psychological and social functioning

  • Osteoporosis is characterised by low bone mineral density (BMD) and deteriorated microarchitecture [7] resulting in increased bone fragility and fracture risk

  • This study demonstrates that men and women with frailty had the highest Fracture risk assessment (FRAX) scores compared to the pre-frail and robust groups, indicating that FRAX is associated with frailty

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Summary

Introduction

Frailty is characterised by age-related declines in physical, psychological and social functioning. Features of frailty overlap with risk factors for fragility fractures. The aim of this study was to investigate the association between the fracture risk assessment tool (FRAX®) and frailty. Frailty is a clinical syndrome characterised by agerelated declines of physical, psychological and social functioning [1, 2]. Frailty is associated with body compositional changes, sarcopenia and osteoporosis, having overlapping pathogenic pathways related to loss of lean muscle mass and function and skeletal deterioration [6]. Osteoporosis is characterised by low bone mineral density (BMD) and deteriorated microarchitecture [7] resulting in increased bone fragility and fracture risk. There is an overlap between the characteristics of individuals with frailty and fragility fracture [10]

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