Fracture Risk Factors in Community-Dwelling Older Adults: Insights from the Canadian Longitudinal Study on Aging

Abstract

Objectives: This study aimed to investigate whether new potential risk factors (cognition, frailty, falls, social isolation/loneliness, and osteosarcopenia), not included in traditional fracture risk prediction models, are associated with fracture risk in community-dwelling older adults. Methods: Participants aged 65 years or older from the Canadian Longitudinal Study on Aging (CLSA) who completed the 2015 baseline and 2018 follow-up assessments were included. The outcome was self-reported fractures in the 12 months prior to both baseline and a three-year follow-up. Baseline predictor variables included cognition variables (memory, executive function, and psychomotor speed), frailty (assessed using the Rockwood Frailty Index), falls (assessed as occurrence at the 12 months prior to baseline), social isolation/loneliness (assessed using the CLSA-Social Isolation Index), and osteosarcopenia defined as a combination of osteopenia/osteoporosis (bone mineral density femoral neck T-score <-1) and sarcopenia (grip strength <35.5 kg for males and <16kg for females, as well as gait speed <0.8 m/s for both sexes). Findings: When considering cognition, frailty, and falls simultaneously, the frailty index was independently associated with fracture risk [adjusted odd ratio (OR) 1.44, 95% confidence interval (CI) 1.11-1.52 per each standard deviation (SD) increment in the frailty index]. The Social Isolation Index was associated with fracture risk (adjusted OR 1.13, 95% CI 1.01-1.27); however, this association was dependent on an interaction with depressive symptoms. In males, osteosarcopenia was associated with a 2.6-fold higher fracture risk compared to those with normal bone density without sarcopenia (adjusted OR 2.60, 95% CI 1.14-5.91). Conclusion: Frailty, social isolation/loneliness, and osteosarcopenia are associated with fracture risk in Canadian community-dwelling older adults aged 65 years or older. These new risk factors may be used in the future to develop better fracture prediction assessments.