Progression of frailty and prevalence of osteoporosis in a community cohort of older womena 10-year longitudinal study

In community dwelling, 75-year-old women followed 10years, a frailty index was created at each of three visits. Frailty score increased by 6-7% annually. A higher frailty score was equivalent to being 5-10years chronologically older. Frailty was associated with low bone density and higher risk of dying.IntroductionTo understand the distribution of frailty among a population-based sample of older community-dwelling women, progression over 10years, and association with mortality and osteoporosis.MethodsThe study is performed in a cohort designed to investigate osteoporosis. The OPRA cohort consists of 75-year-old women, n=1044 at baseline, and follow-up at age 80 and 85. A frailty index (scored from 0.0-1.0) based on deficits in health across multiple domains was created at all time-points; outcomes were mortality up to 15years and femoral neck bone density.ResultsAt baseline, the proportion least frail, i.e., most robust (FI 0.0-0.1) constituted 48%, dropping to 25 and 14% at age 80 and 85. On average, over 10years, the annual linear frailty score progression was approximately 6-7%. Among the least frail, 11% remained robust over 10years. A higher frailty score was equivalent to being 5 to 10years older. Mortality was substantially higher in the highest quartile compared to the lowest based on baseline frailty score; after 10years, 48.7% had died vs 17.2% (p=1.7x10(-14)). Mortality risk over the first 5years was highest in the frailest (Q4 vs Q1; HRunadj 3.26 [1.86-5.73]; p<0.001) and continued to be elevated at 10years (HRunadj 3.58 [2.55-5.03]; p<0.001). Frailty was associated with BMD after adjusting for BMI (overall p=0.006; Q1 vs Q4 p=0.003).ConclusionsThe frailty index was highly predictive of mortality showing a threefold increased risk of death in the frailest both in a shorter and longer perspective. Only one in ten older women escaped progression after 10years. Frailty and osteoporosis were associated.