Citation

Alajlouni DAD, Bliuc DD, Tran TSD, Blank RP, Cawthon PMP, Ensrud KD, Lane ND, Orwoll ESP, Cauley JAD, Center JRP. J. Bone Miner. Res. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, American Society for Bone and Mineral Research)

DOI

10.1002/jbmr.4619

PMID

35689796

Abstract

Muscle strength and physical performance are associated with incident fractures and mortality. However, their role in the risk of subsequent fracture and post-fracture mortality is not clear. We assessed the association between muscle strength (grip strength) and performance (gait speed and chair stands time) and the risk of subsequent fracture and mortality in 830 men with low-trauma index fracture, who participated in MrOS USA Study and had their index measurements assessed within 5 years prior to the index fracture. The annual decline in muscle strength and performance following index fracture, estimated using linear mixed-effects regression, was also examined in relation to mortality. The associations were assessed using Cox's proportional hazards models adjusted for age, FN BMD, prior fractures, falls, BMI, index fracture site, lifestyle factors, and comorbidities. Over a median follow-up of 3.7 (IQR: 1.3-8.1) years from index fracture to subsequent fracture, 201 (24%) men had a subsequent fracture, and over 5.1 (1.8-9.6) years to death, 536 (65%) men died. Index measurements were not associated with subsequent fracture (Hazard ratios (HRs) ranging from 0.97 to 1.07). However, they were associated with post-fracture mortality. HR (95% CI) per 1 SD decrement in grip strength: 1.12 (1.01-1.25) and gait speed: 1.14 (1.02-1.27), and 1 SD increment in chair stands time: 1.08 (0.97-1.21). Greater annual declines in these measurements were associated with higher mortality risk, independent of the index values and other covariates. HR (95% CI) per 1 SD annual decrement in change in grip strength: 1.15 (1.01-1.33) and in gait speed: 1.38 (1.13-1.68), and 1 SD annual increment in chair stands time: 1.28 (1.07-1.54). Men who were unable to complete one or multiple tests had greater risk of post-fracture mortality (24%-109%) compared to those performed all tests. It remains to be seen whether improvement in these modifiable factors can reduce post-fracture mortality. This article is protected by copyright. All rights reserved.

Language: en

Keywords

Aging; Fracture Prevention; Fracture Risk Assessment Screening; General Population Studies; Muscle Strength; Physical Performance; Post-Fracture Mortality; Sarcopenia; Subsequent Fracture