A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men
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OBJECTIVES: To compare the validity of a parsimonious frailty index (components: weight loss, inability to rise from a chair, and poor energy (Study of Osteoporotic Fractures (SOF) index)) with that of the more complex Cardiovascular Health Study (CHS) index (components: unintentional weight loss, low grip strength, poor energy, slowness, and low physical activity) for prediction of adverse outcomes in older men. DESIGN: Prospective cohort study. SETTING: Six U.S. centers. PARTICIPANTS: Three thousand one hundred thirty‐two men aged 67 and older. MEASUREMENTS: Frailty status categorized as robust, intermediate stage, or frail using the SOF index and criteria similar to those used in CHS index. Falls were reported three times for 1 year. Disability (≥1 new impairments in performing instrumental activities of daily living) ascertained at 1 year. Fractures and deaths ascertained during 3 years of follow‐up. Analysis of area under the receiver operating characteristic curve (AUC) statistics compared for models containing the SOF index versus those containing the CHS index. RESULTS: Greater evidence of frailty as defined by either index was associated with greater risk of adverse outcomes. Frail men had a higher age‐adjusted risk of recurrent falls (odds ratio (OR)=3.0–3.6), disability (OR=5.3–7.5), nonspine fracture (hazard ratio (HR)=2.2–2.3), and death (HR=2.5–3.5) ( P <.001 for all models). AUC comparisons revealed no differences between models with the SOF index and models with the CHS index in discriminating falls (AUC=0.63, P =.97), disability (AUC=0.68, P =.86), nonspine fracture (AUC=0.63, P =.90), or death (AUC=0.71 for model with SOF index and 0.72 for model with CHS index, P =.19). CONCLUSION: The simple SOF index predicts risk of falls, disability, fracture, and mortality in men as well as the more‐complex CHS index.
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Obesity may increase fracture risk through bone quality or frailty independently of bone mineral density.
“Obesity is inversely related to BMD and fractures313 but might increase the fracture risk through bone quality314,315 or frailty132,316 independent of BMD.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [316]
The Results report that frail older men had higher age-adjusted nonspine fracture risk, and the multivariable prediction models included femoral-neck BMD. The paper does not show that obesity increases fracture risk through frailty, or establish frailty as a causal pathway independent of BMD; bone quality is associated with other citations in the citing sentence. (LLM, conf=0.85)
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- Authors
- Ensrud, K. E., Ewing, S. K., Cawthon, P. M., Fink, H. A., Taylor, B. C., Cauley, J. A., Dam, T., Marshall, L. M., Orwoll, E. S., Cummings, S. R., & for the Osteoporotic Fractures in Men Research Group
- Affiliations
- University of Minnesota (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2009-03
- Volume
- 57
- Issue
- 3
- Pages
- 492-498
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC2861353
- OpenAlex
- W1525398982
- Cited by
- 636
- References
- 38
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 33 · 2023: 31 · 2022: 53 · 2021: 42 · 2020: 58 · 2019: 36 · 2018: 37 · 2017: 48 · 2016: 41 · 2015: 40 · 2014: 33 · 2013: 34 · 2012: 42
- FWCI
- 24.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (U01-AG-18197, U01AG018197, U01AG027810, U01AG042140)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR45614, U01-AR45632, U01 AR45647, U01AR045583, U01 AR-45583, U01-AR-45654, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, U01AR066160, U01AR45580)
- National Center for Research Resources (UL1RR024140)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- frailty index, older men, falls, disability, fracture, mortality, frailty assessment, instrumental activities of daily living, weight loss, grip strength, energy status, physical activity
- MeSH terms
- Accidental Falls, Activities of Daily Living, Aged, 80 and over, Disability Evaluation, Follow-Up Studies, Fractures, Spontaneous, Humans, Male, Prospective Studies, Risk, Weight Loss, Geriatric Assessment, Proportional Hazards Models, Survival Analysis, Frail Elderly, Hand Strength, Mobility Limitation
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