Cognition, frailty and falls: should they be part of fracture risk assessment?

Osteoporosis is a disease that causes your bones to break more easily. It puts people at higher risk for illness, death, and worse quality of life. The likelihood of breaking a bone can be calculated using fracture risk assessment tools like the FRAX and CAROC, which include items like age, sex, and bone mineral density. They do not include items that are relevant to older adults like cognitive impairment, frailty, and falls. Our study will examine the association between fractures, cognition, frailty, and falls using data from the Canadian Longitudinal Study on Aging. Our study will help determine if these items should be added to current fracture risk assessment to help predict fractures better.

The primary objective was to examine the association between self-reported incident fractures and cognition, frailty, and falls at three-year follow-up, after controlling for traditional risk fractures (e.g., bone mineral density). Our study found that frailty was independently associated with self-reported incident fractures in both participants of all ages and in those aged 65 years or older, whereas a history of one or more falls was independently associated with self-reported fractures in participants of all ages. In addition, the Rey Auditory Verbal Learning Test (RAVLT): immediate recall test was associated with self-reported incident fractures in participants of all ages and the Miami Prospective Memory Test (MPMT) was associated with fractures in those aged 65 years or older. No other performance measures were associated with self-reported incident fractures, so the association between RAVLT: immediate recall test or MPMT and fractures may be spurious. The mean value of the cognitive performance among participants with and without self-reported incident fractures was similar. Thus, our results can also provide a basis for future studies to examine if adding frailty and a history of falls increases the predictive accuracy of current fracture risk assessment tools. Our results also support further study of nonpharmacological interventions for fracture prevention.