Combining frailty and bone mineral density improves fracture risk assessment

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Combining frailty assessments with bone mineral density (BMD) measurements significantly improves the accuracy of predicting fracture risk in individuals over 50, compared to using either measure alone, according to a study.

Researchers analyzed data from 5126 rural Koreans, including 1955 males (38.1%) and 3171 females (61.9%).

Results showed that low BMD was associated with an increased risk of fractures. Specifically, osteoporosis was linked to a higher risk for any type of fracture (OR 1.89), hip fracture (OR 2.05), and other fractures (OR 2.18), though no significant risk was found for vertebral fractures. Frailty alone was also a strong predictor of fractures, with frail individuals showing a higher risk for any fracture (OR 2.12), vertebral fractures (OR 2.48), and hip fractures (OR 2.52).

The study’s findings indicate that the combination of frailty and BMD provides a more accurate assessment of fracture risk compared to using either measure alone, particularly for individuals over 50 years old. The combined approach showed superior risk prediction for major osteoporotic fractures (MOF) with an area under the curve (AUC) of 0.825 (P = 0.000).

Subgroup analyses revealed that frail women with osteoporosis faced the highest risk for fractures, especially vertebral (OR 5.12) and MOF (OR 5.19). Individuals ≥70 years old demonstrated significantly higher fracture risks compared to those <70 years.

Lee J, Kim J, Jeong C, et al. Predicting Fragility Fractures Based on Frailty and BMD Among Rural Community-Dwelling Older Adults. Eur J Endocrinol. 2024;lvae080. doi: 10.1093/ejendo/lvae080. Epub ahead of print. PMID: 38970525.