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A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men
Open accessAbstract
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 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]
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A machine learning model for frailty based on wearable device measurements
Culos, A., Mañas, A., Shidara, K., Fallazadeh, R., Garcia‐Garcia, F. J., Losa‐Reyna, J., Alegre, L. M., Rodríguez‐Mañas, L., Chang, A. L., Espinosa, C. A., et al. (2026) · Communications Medicine · doi:10.1038/s43856-026-01419-7 · Cited by 5
“Frailty is a clinically relevant syndrome in the elderly population associated with increased risk for falls, incident disability, hospitalization, and mortality 6,38 – 41 .”
Pincombe, A., Afzali, H. H. A., Visvanathan, R., & Karnon, J. D. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290567 · Cited by 3
Ensrud, K. E., Schousboe, J. T., Kats, A. M., Fink, H. A., Taylor, B. C., Sheets, K. M., Boyd, C. M., & Langsetmo, L. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19287 · Cited by 3
Self-citationSarcopenia and Frailty: the detectable overlapping and the possible diagnostic approaches
Therapist, P., & Nikolaou, D. (2016) · Journal of Frailty Sarcopenia and Falls · doi:10.22540/jfsf-01-008 · Cited by 3
Routinization: risk factor or marker of adjustment to negative health issues?
Bergua, V., Meillon, C., Pérès, K., Dartigues, J., Bouisson, J., & Amieva, H. (2022) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5682 · Cited by 2
Suggestions on the ideal method of conducting community screenings for older adults
Kouzuki, M., Tanaka, N., Miyamoto, M., & Urakami, K. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04119-2 · Cited by 3
Systematic review of methods used in prediction models with recurrent event data
Watson, V., Smith, C. T., & Bonnett, L. J. (2024) · Diagnostic and Prognostic Research · doi:10.1186/s41512-024-00173-5 · Cited by 3
Naumov, A. V., Khovasova, N. O., Meshkov, A. D., Unkovskiy, A. V., К., Ф. Д., Kotovskaya, Y. V., & Ткачева, О. Н. (2025) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-2-2025-125-144 · Cited by 3
Relationship between IL-6, IL-1β, and vitamin D on frailty status in elderly women
Ngestiningsih, D., Dayanti, J. K., & Batubara, L. (2021) · Bali Medical Journal · doi:10.15562/bmj.v10i1.2177 · Cited by 3
Shahrestani, S., Brown, N. J., Strickland, B. A., Bakhsheshian, J., Ghodsi, S. M., Nasrollahi, T. S., Borrelli, M., Gendreau, J. L., Ruzevick, J., & Zada, G. (2022) · Neurosurgical FOCUS · doi:10.3171/2022.2.focus21782 · Cited by 3
Fragilidade e qualidade de vida em idosos
Rabelo, M. A., de Souza, D. M. S. T., Galhardo, V. Â. C., & Mello, J. L. D. C. (2023) · Research Society and Development · doi:10.33448/rsd-v12i3.40738 · Cited by 3
Szulc, P., Chapurlat, R. D., & Delmas, P. D. (2010) · Journal of Men s Health · doi:10.1016/j.jomh.2010.08.001 · Cited by 3
“Frailty may be associated with low aBMD and higher mortality [43,44].”
Anesthetic Management of Thoraco-Abdominal Open Procedures
Castillo, J. G., Silvay, G., & Fischer, G. W. (2011) · Springer eBooks · doi:10.1007/978-88-470-1857-0_21 · Cited by 3
La fragilité des personnes âgées
Rétornaz, F., Karunananthan, S., Sourial, N., Vedel, I., & Bergman, H. (2013) · Presses de l’EHESP eBooks · doi:10.3917/ehesp.bela.2013.01.0123 · Cited by 3
Terminal Weight Loss, Frailty, and Mortality
Masoro, E. J. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-378638-8.00014-2 · Cited by 3
Carbone, A., Fuschi, A., Al-Rawashdah, S. F., Salhi, Y. A., Velotti, G., Ripoli, A., Autieri, D., Palleschi, G., & Pastore, A. L. (2016) · International Journal of Clinical Practice · doi:10.1111/ijcp.12849 · Cited by 3
Implications of Frailty among Men with Implantable Cardioverter Defibrillators
Picel, K., Vo, T., Kealhofer, J. V., Anand, V., Ensrud, K. E., & Adabağ, S. (2020) · Southern Medical Journal · doi:10.14423/smj.0000000000001137 · Cited by 3
“The performance of the Study of Osteoporotic Fractures frailty scale in predicting risk of adverse clinical outcomes including incident disability, falls, fractures, and mortality is similar to that of the more complex frailty index based on five components developed using data from the Cardiovascular Health Study.13,…”
BackgroundMethodResultInfluentialSelf-citationSchmidle, S., Gulde, P., Jansen, B., Herdegen, S., & Hermsdörfer, J. (2020) · Communications in computer and information science · doi:10.1007/978-3-030-60703-6_12 · Cited by 3
Screening Gait Performance, Falls, and Physical Activity among Benedictine and Trappist Monks
Klima, D. W., & Davey, A. (2021) · Journal of Primary Care & Community Health · doi:10.1177/2150132721990187 · Cited by 3
Frailty inclusive care in acute and community-based settings: a systematic review protocol
Montgomery, C., Hopkin, G., Bagshaw, S. M., Hessey, E., & Rolfson, D. B. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01638-0 · Cited by 3
Comparative Performance of Three Claims-Based Frailty Measures Among Medicare Beneficiaries
Heins, S. E., Agniel, D. M., Mann, J., & Sorbero, M. E. S. (2023) · Journal of Applied Gerontology · doi:10.1177/07334648231223449 · Cited by 2
“While there is no single de fi nition of frailty, it is generally characterized by a collection of symptoms including unintentional weight loss, decreased strength, and increased susceptibility to falls and fractures (Ensrud et al., 2009; Fried et al., 2001; Xue, 2011).”
BackgroundSimo, N., Letchimy, L., Mounsamy, L., Rinaldo, L., Vainqueur, L., Essomba, M.-J. N., Mallet, G., Boucaud‐Maitre, D., & Tabué-Teguo, M. (2024) · Healthcare · doi:10.3390/healthcare12151471 · Cited by 2
“This finding is not consistent with the data in the literature, where it is well established that cognitive impairment is a risk factor for falls [24,30,31].”
ResultFrailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC study
Mestre, A. B., Afonso, R., Simões, A. F., Correia, I., & Gonçalves-Pereira, J. (2025) · Critical Care Science · doi:10.62675/2965-2774.20250229 · Cited by 2
Jankowska‐Polańska, B., Tomasiewicz, A., Polański, J., & Tański, W. (2025) · Nutrition · doi:10.1016/j.nut.2025.112850 · Cited by 2
Özdemir, R., & Yaman, F. (2025) · Medicina · doi:10.3390/medicina61060969 · Cited by 2
“Frailty is a clinically identifiable state of heightened vulnerability resulting from age-related declines in physiological systems and functions, leading to impaired resilience to stressors [16–18].”
Ko, C., Feng, M., Chao, C.-L., Hung, C., Hou, M.-L., Wu, M.-F., & Wu, S.-H. (2025) · Scientific Reports · doi:10.1038/s41598-025-05403-4 · Cited by 2
“Participants who exhibit none of three components are classified as robust, whereas those demonstrating one component are considered to be in an intermediate stage of frailty 28 .”
Tolerability of immune checkpoint inhibitors for cancer treatment in frail, older patients
Sheppard, R., Anstey, C., Hanjani, L. S., Ladwa, R., Berry, R., Fletcher, J. A., & Hubbard, R. E. (2025) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2025.102829 · Cited by 2
Old-age Frailty Patterns and Implications for Long-term Care Programmes
Fong, J. H. Y. (2016) · The Geneva Papers on Risk and Insurance Issues and Practice · doi:10.1057/s41288-016-0006-3 · Cited by 2
An optimized system for mobility evaluation in frailty phenotype assessment
Pierleoni, P., Belli, A., Pinti, F., Paoletti, M., Raggiunto, S., & Palma, L. (2022) · Journal of Ambient Intelligence and Humanized Computing · doi:10.1007/s12652-022-03802-3 · Cited by 2
“Frailty is a condition of increase in vulnerability caused by a cumulative decline in the physiologic systems resulting risk of disability, morbidity, psychological decline, hospitalization, and mortality (Ensrud et al. 2009).”
Heins, S. E., Agniel, D. M., Mann, J., & Sorbero, M. E. S. (2023) · Journal of Applied Gerontology · doi:10.1177/07334648231162613 · Cited by 2
Perazza, L. R., Avers, D., & Thompson, L. V. (2023) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0000000000000389 · Cited by 2
Tzeng, Y.-M., Kao, S., Chen, W.-L., Chen, S.-F., Li, S.-R., Chiu, Y., Chang, Y.-T., & Chang, Y. (2025) · Aging · doi:10.18632/aging.206231 · Cited by 2
Overall Approach to the Evaluation and Treatment of Osteoporosis in Men
ORWOLL, E. S. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-374602-3.00048-1 · Cited by 2
Self-citationNgestiningsih, D., Sukmaningtyas, H., Susanto, T. G., & Probosari, E. (2020) · Bali Medical Journal · doi:10.15562/bmj.v9i3.2147 · Cited by 2
Metadata
- 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 (medical) › 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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