Skip to main content
Log in

A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos)

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We created a 30-item Frailty Index in the Canadian Multicentre Osteoporosis Study. A Frailty Index is a sensitive measure that can quantify fracture risk according to degree of frailty. Our results indicated that at any age, frailty was an important independent risk factor for fracture over 10 years.

Introduction

In later life, frailty has been linked to fractures. It is likely that the antecedents of fracture are seen across the life course, in ways not entirely captured by traditional osteoporosis risk factors. Using data collected from the prospective, population-based Canadian Multicentre Osteoporosis Study (CaMos), we created the 30-item CaMos Frailty Index and examined whether it was associated with incident fractures over 10 years.

Methods

All CaMos participants aged 25 years and older (n = 9,423) were included in the analysis. To examine the relationship between baseline Frailty Index scores and incident fractures, a competing risk proportional sub-distribution hazards model was used with death considered a competing risk. Analyses were adjusted for age, sex, body mass index, education level, femoral neck T-score, and antiresorptive therapy.

Results

At baseline, the mean age was 62.1 years [standard deviation (SD) 13.4], and 69.4 % were women. The mean Frailty Index score was 0.13 (SD 0.11), ranging from 0 to 0.66. For every 0.10 increase in Frailty Index scores (approximately one SD), the hazard ratio was 1.25 (p < 0.001) for all fractures, 1.18 (p = 0.043) for hip fractures, and 1.30 (p ≤ 0.001) for clinical vertebral fractures.

Conclusion

The CaMos Frailty Index quantified fracture risk according to degree of frailty. Irrespective of age and bone mineral density, the Frailty Index was associated with hip, vertebral, and all-type clinical fractures. Predicting late onset illnesses may have to consider overall health status and not just traditional risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1
Fig 2
Fig 3

Similar content being viewed by others

References

  1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–95. doi:10.1503/cmaj.050051

    Article  PubMed Central  PubMed  Google Scholar 

  2. Rockwood K, Mitnitski A (2011) Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 27:17–26. doi:10.1016/j.cger.2010.08.008

    Article  PubMed  Google Scholar 

  3. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381:752–62. doi:10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  4. Crome P, Lally F (2011) Frailty: joining the giants. CMAJ 183:889–90. doi:10.1503/cmaj.110626

    Article  PubMed Central  PubMed  Google Scholar 

  5. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–56

    Article  CAS  PubMed  Google Scholar 

  6. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K (2006) Validity and reliability of the Edmonton Frail Scale. Age Ageing 35:526–9. doi:10.1093/ageing/afl041

    Article  PubMed  Google Scholar 

  7. Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 1:323–36. doi:10.1100/tsw.2001.58

    Article  CAS  PubMed  Google Scholar 

  8. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24. doi:10.1186/1471-2318-8-24

    Article  PubMed Central  PubMed  Google Scholar 

  9. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM, for the Study of Osteoporotic Fractures Research Group (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 62:744–51

    Article  PubMed  Google Scholar 

  10. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168:382–9. doi:10.1001/archinternmed.2007.113

    Article  PubMed  Google Scholar 

  11. Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR, Osteoporotic Fractures in Men Research Group (2009) A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 57:492–8. doi:10.1111/j.1532-5415.2009.02137.x

    Article  PubMed Central  PubMed  Google Scholar 

  12. Tom SE, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Gehlbach SH, Greenspan SL, Hooven FH, Nieves JW, Pfeilschifter J, Roux C, Silverman S, Wyman A, LaCroix AZ, GLOW Investigators (2013) Frailty and fracture, disability, and falls: a multiple country study from the global longitudinal study of osteoporosis in women. J Am Geriatr Soc 61:327–34. doi:10.1111/jgs.12146

    Article  PubMed Central  PubMed  Google Scholar 

  13. Fang X, Shi J, Song X, Mitnitski A, Tang Z, Wang C, Yu P, Rockwood K (2012) Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the Beijing Longitudinal Study of Aging. J Nutr Health Aging 16:903–7. doi:10.1007/s12603-012-0368-6

    Article  CAS  PubMed  Google Scholar 

  14. Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB, Initiative W’s H (2005) Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 53:1321–30. doi:10.1111/j.1532-5415.2005.53405.x

    Article  PubMed  Google Scholar 

  15. de Vries OJ, Peeters GM, Lips P, Deeg DJ (2013) Does frailty predict increased risk of falls and fractures? A prospective population-based study. Osteoporos Int 24:2397–403. doi:10.1007/s00198-013-2303-z

    Article  PubMed  Google Scholar 

  16. Song X, Mitnitski A, Rockwood K (2011) Nontraditional risk factors combine to predict Alzheimer disease and dementia. Neurology 77:227–34. doi:10.1212/WNL.0b013e318225c6bc

    Article  PubMed Central  PubMed  Google Scholar 

  17. Sterniczuk R, Theou O, Rusak B, Rockwood K (2013) Sleep disturbance is associated with incident dementia and mortality. Curr Alzheimer Res 10:767–75

    Article  CAS  PubMed  Google Scholar 

  18. Wallace L, Theou O, Rockwood M, Kirkland S, Rockwood K, Shimbo D, Davidson K (2013) Considering both non-traditional and traditional risk factors improves the prediction of coronary heart disease events. Can Ger J 16:66–103

    Google Scholar 

  19. Schoufour JD, Mitnitski A, Rockwood K, Evenhuis HM, Echteld MA (2013) Development of a frailty index for older people with intellectual disabilities: results from the HA-ID study. Res Dev Disabil 34:1541–55. doi:10.1016/j.ridd.2013.01.029

    Article  PubMed  Google Scholar 

  20. Kreiger N, Tenenhouse A, Joseph L, Mackenzie T, Poliquin S, Brown JP, Prior JC, Rittmaster RS (1999) The Canadian Multicentre Osteoporosis Study (CaMos): background, rationale, methods. Canadian J Aging 18:376–87

    Article  Google Scholar 

  21. Tenenhouse A, Joseph L, Kreiger N, Poliquin S, Murray TM, Blondeau L, Berger C, Hanley DA, Prior JC, CaMos Research Group, Canadian Multicentre Osteoporosis Study (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904

    Article  CAS  PubMed  Google Scholar 

  22. Kulminski A, Yashin A, Arbeev K, Akushevich I, Ukraintseva S, Land K, Manton K (2007) Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: results from analyses of the National Long Term Care Survey. Mech Ageing Dev 128:250–8. doi:10.1016/j.mad.2006.12.004

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I (2006) Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 54:975–9. doi:10.1111/j.1532-5415.2006.00738.x

    Article  PubMed  Google Scholar 

  24. Rockwood K, Andrew M, Mitnitski A (2007) A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 62:738–43

    Article  PubMed  Google Scholar 

  25. Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  26. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K (2002) Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 2:1

    Article  PubMed Central  PubMed  Google Scholar 

  27. Cesari M, Gambassi G, Abellan van Kan G, Vellas B (2013) The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing. doi:10.1093/ageing/aft160

    Google Scholar 

  28. Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI (2008) Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 56:898–903. doi:10.1111/j.1532-5415.2008.01656.x

    Article  PubMed Central  PubMed  Google Scholar 

  29. Hubbard RE, O’Mahony MS, Woodhouse KW (2009) Characterising frailty in the clinical setting—a comparison of different approaches. Age Ageing 38:115–9. doi:10.1093/ageing/afn252

    Article  PubMed  Google Scholar 

  30. Collerton J, Martin-Ruiz C, Davies K, Hilkens CM, Isaacs J, Kolenda C, Parker C, Dunn M, Catt M, Jagger C, von Zglinicki T, Kirkwood TB, Collerton J, Martin-Ruiz C, Davies K, Hilkens CM, Isaacs J, Kolenda C, Parker C, Dunn M, Catt M, Jagger C, von Zglinicki T, Kirkwood TB (2012) Frailty and the role of inflammation, immunosenescence and cellular ageing in the very old: cross-sectional findings from the Newcastle 85+ Study. Mech Ageing Dev 133:456–66. doi:10.1016/j.mad.2012.05.005

    Article  CAS  PubMed  Google Scholar 

  31. Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hebert R, Hogan DB, Wolfson C, McDowell I (2004) Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci 59:1310–7

    Article  PubMed  Google Scholar 

  32. Bennette C, Vickers A (2012) Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. BMC Med Res Methodol 12:21. doi:10.1186/1471-2288-12-21

    Article  PubMed Central  PubMed  Google Scholar 

  33. Garcia-Gonzalez JJ, Garcia-Pena C, Franco-Marina F, Gutierrez-Robledo LM (2009) A frailty index to predict the mortality risk in a population of senior Mexican adults. BMC Geriatr 9:47. doi:10.1186/1471-2318-9-47

    Article  PubMed Central  PubMed  Google Scholar 

  34. Berry SD, Ngo L, Samelson EJ, Kiel DP (2010) Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc 58:783–7. doi:10.1111/j.1532-5415.2010.02767.x

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Courtney C. Kennedy was supported by Osteoporosis Canada—Canadian Multicentre Osteoporosis Study Fellowship Awards (2011–2013).

Conflicts of interest

Kenneth Rockwood discloses that the Dalhousie University Industry-Liaison Office is reviewing the commercialization potential of one version of the Frailty Index (not the one used here) based on a Comprehensive Geriatric Assessment.

Dr. Alexandra Papaioannou has received grants and research support from Amgen, Eli Lilly, Merck Canada Inc., Warner Chilcott and consults for Amgen, Eli Lilly.

Dr. Jonathan Adachi consults for and has received lecture fees from Amgen, Eli Lilly, Merck, Novartis, Warner Chilcott.

Courtney C. Kennedy, George Ioannidis, Lehana Thabane, Susan Kirkland, and Laura E. Pickard declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to C. C. Kennedy or A. Papaioannou.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kennedy, C.C., Ioannidis, G., Rockwood, K. et al. A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 25, 2825–2832 (2014). https://doi.org/10.1007/s00198-014-2828-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-014-2828-9

Keywords

Navigation