The influence of immobility on muscle loss in older people with frailty and fragility fractures.

Abstract

This longitudinal study aimed to assess muscle morphological and functional changes in older patients admitted with fragility fractures managed by immobilisation of the affected limb for at least 6weeks. Patients aged ≥ 70 hospitalised with non-weight bearing limb fractures, and functionally limited to transfers only, were recruited. Handgrip (HGS) and knee extensor strength (KES), Vastus Lateralis muscle thickness (VLMT) and cross-sectional area at ultrasound (VLCSA) were measured in the non-injured limb at hospital admission, 1, 3 and 6weeks later. Barthel Index, mobility aid use and residential status were recorded at baseline and 16weeks. Longitudinal changes in muscle measurements were analysed using one-way repeated measures ANOVA. In a sub-study, female patients' baseline measurements were compared to 11 healthy, female, non-frail, non-hospitalised control volunteers (HC) with comparable BMI, aged ≥ 70, using independent t tests. Fifty patients (44 female) participated. Neither muscle strength nor muscle size changed over a 6-week immobilisation. Dependency increased significantly from pre-fracture to 16weeks. At baseline, the patient subgroup was weaker (HGS 9.2 ± 4.7kg vs. 19.9 ± 5.8kg, p < 0.001; KES 4.5 ± 1.5kg vs. 7.8 ± 1.3kg, p < 0.001) and had lower muscle size (VLMT 1.38 ± 0.47cm vs. 1.75 ± 0.30cm, p = 0.02; VLCSA 8.92 ± 4.37 cm2 vs. 13.35 ± 3.97 cm2, p = 0.005) than HC. The associations with lower muscle strength measures but not muscle size remained statistically significant after adjustment for age. Patients with non-weight bearing fractures were weaker than HC even after accounting for age differences. Although functional dependency increased after fracture, this was not related to muscle mass or strength loss, which remained unchanged.