Frailty status and the risk of fractures in older people: the Pro.V.A. Longitudinal study

Background and aims. Frailty has been associated with an increased risk of fractures in older people, but the mechanisms behind this relationship have yet to be fully elucidated. We aimed to investigate which frailty criteria were more closely associated with the risk of fractures in community-dwelling older people. Methods. This study analyzed data from 2,113 older men and women enrolled in the Progetto Veneto Anziani (ProVA) study and with no fractures at baseline. Frailty was assessed at baseline and defined as the presence of at least three out of five Fried criteria, pre-frailty was the presence of one or two criteria, while non-frailty was the presence of none of the criteria. Fractures after a mean 4-year follow-up were assessed on the basis of medical records, self-reports, and radiographic examinations. Results. At follow-up, we identified 233 (11 %) new cases of fracture, with an age- and gender-specific incidence rate of 22/1000 person-years (95% CI: 11-36). Compared with the non-frail, frail and pre-frail individuals carried a significant 59% (OR = 1.59, 95% CI: 1.31-1.93) and 21 % (OR = 1.21, 95% CI: 1.09-1.34) higher risk of fractures, respectively. Among the frailty determinants, slow gait raised the likelihood of fractures by 56%, physical inactivity by 46%, exhaustion by 32%, and weakness by 31 %. No significant associations with unintentional weight loss emerged after adjusting for potential confounders. Conclusions. Frailty may predict the occurrence of fractures in older people, probably through mechanisms mediated by impaired physical performance and exhaustion. Slow gait seems to be the most relevant factor in increasing the risk of fractures in advanced age.