LATE PHYSICAL AND FUNCTIONAL-EFFECTS OF OSTEOPOROTIC FRACTURE IN WOMEN - THE RANCHO-BERNARDO STUDY

OBJECTIVE: To examine the associations between osteoporotic fractures and difficulty performing selected physical and functional activities. DESIGN: Cross sectional analysis of a cohort study. SETTING: Geographically defined cohort located in Rancho Bernardo, California. PARTICIPANTS: Community-dwelling women aged 55 and older who participated in a study of osteoporosis between 1988-1991. Eighty percent of eligible women participated in the study. MAIN OUTCOME MEASURES: Self-reported difficulty performing seven physical activities and four functional tasks. RESULTS: The mean age of the 1010 women was 72.6 years. A total of 160 first minimal trauma fractures occurred between 1972 and 1991, including 62 wrist, 29 rib, 25 hip, and 23 spine fractures. The mean time since fracture was 6.7 years (range, 1 to 17 years). In multiply adjusted analyses, having experienced any osteoporotic fracture was significantly associated with a 1.7 to 3.0-fold increase in difficulty bending, lifting, reaching, walking, climbing stairs, and descending stairs. Any fracture was significantly associated with 1.9 to 6.7 times more difficulty in dressing, cooking, shopping, and performing heavy housework. Compared with the relative odds of physical limitation associated with any osteoporotic fracture, hip fractures were more strongly associated with difficulty walking (OR 3.6) and descending stairs (OR 4.1), whereas spine fractures demonstrated a stronger association with difficulty bending (OR 3.1), lifting (OR 3.4), and descending stairs (OR 4.2). CONCLUSIONS: Among older women, remote osteoporotic fracture at any site is associated with an approximate doubling of the risk of physical limitations and an even higher risk of functional limitations. Although this cross-sectional analysis cannot secure the direction of the association, the specificity of the effect of particular fractures on discrete activities supports causality.