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Incident fracture associated with increased risk of mortality even after adjusting for frailty status in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study

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Abstract

Summary

Frail elderly individuals have elevated risks of both fracture and mortality. We found that incident fractures were associated with an increased risk of death even after adjusting for pre-fracture frailty status as represented by physical performance tests and laboratory tests for common geriatric diseases in community-dwelling elderly Japanese men.

Introduction

While fractures reportedly increase the risk of mortality, frailty may complicate this association, generating a false-positive result. We evaluated this association after adjusting for pre-fracture levels of frailty.

Methods

We examined 1998 community-dwelling ambulatory men aged ≥65 years at baseline in the Fujiwara-kyo Osteoporosis Risk in Men Study for frailty status as represented by activities of daily living (ADL), physical performance tests (grip strength, one-foot standing balance with eyes open, timed 10-m walk), and laboratory sera tests. Participants were then followed for 5 years for incident clinical fractures and death. Effects of incident fracture on death were determined by Cox proportional hazards model with the first fracture during follow-up as a time-dependent predictor and with frailty status indices as covariates.

Results

We identified 111 fractures in 99 men and 138 deaths during the follow-up period (median follow-up, 4.5 years). Participants with incident fractures did not have significantly worse frailty statuses, but did show a significantly higher cumulative mortality rate than those without fractures (p = 0.0047). Age-adjusted hazard ratio (HR) of death for incident fracture was 3.57 (95 % confidence interval: 2.05, 6.24). When adjusted for physical performance, this decreased to 2.77 (1.51, 5.06), but remained significant. The HR showed no significant change when adjusted for laboratory test results (3.96 (2.26, 6.94)). Exclusion of deaths within the first 24 months of follow-up did not alter these results.

Conclusion

Incident clinical fracture was associated with an elevated risk of death independently of pre-fracture levels of frailty in community-dwelling elderly men.

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Acknowledgments

The Fujiwara-kyo Study Group (chaired by Norio Kurumatani with Nozomi Okamoto as secretary general) comprising Nobuko Amano, Yuki Fujita, Akihiro Harano, Kan Hazaki, Masayuki Iki, Junko Iwamoto, Akira Minematsu, Masayuki Morikawa, Keigo Saeki, Noriyuki Tanaka, Kimiko Tomioka, and Motokazu Yanagi performed most non-skeletal measures in the present study and provided data for the FORMEN Study. The FORMEN Study was supported by Grants-in-Aid for Scientific Research (#20659103: 2008-2009, #21390210: 2009-2011, #20590661: 2008-2010) from the Japanese Society for the Promotion of Science; a Grant-in-Aid for Young Scientists (#20790451: 2008-2010) from the Japanese Ministry of Education, Culture, Sports, Science and Technology, a Grant-in-Aid for Study on Milk Nutrition (2008) from the Japan Dairy Association, a Grant (2007) from the Foundation for Total Health Promotion, a St. Luke’s Life Science Institute Grant-in-Aid for Epidemiological Research (2008), and a Grant (2008) from the Physical Fitness Research Institute, MEIJIYASUDA Life Foundation of Health and Welfare. The funding bodies and collaborators had no role in designing the study, in analyzing or interpreting the data, in writing the manuscript, or in deciding where to submit the manuscript for publication. The authors thank Toyukai Medical Corporation (Tokyo, Japan), Toyo Medic Corporation (Tokyo, Japan), and SRL Inc. (Tokyo, Japan) for their technical assistance.

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Authors and Affiliations

  1. Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    M. Iki, Y. Fujita, K. Kouda & A. Yura

  2. Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    J. Tamaki

  3. Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan

    Y. Sato

  4. Department of Nursing, Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Kita-Katsuragi-gun, Koryo-cho, Nara, 635-0832, Japan

    J. S. Moon

  5. Department of Orthopedics, Yamato-Takada Municipal Hospital, 1-1 Isonokitamachi, Yamato-Takada, Nara, 635-8501, Japan

    A. Harano

  6. Department of Physical Therapy, Faculty of Biomedical Engineering, Osaka Electro-Communication University, 18-8 Hatsucho, Neyagawa, Osaka, 572-8530, Japan

    K. Hazaki

  7. Department of Public Health and Home Nursing, Graduate School of Medical Sciences, Nagoya University, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan

    E. Kajita, M. Hamada & K. Arai

  8. Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan

    K. Tomioka, N. Okamoto & N. Kurumatani

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  1. M. Iki
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  2. Y. Fujita
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  3. J. Tamaki
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  4. K. Kouda
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  7. J. S. Moon
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  8. A. Harano
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  9. K. Hazaki
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  10. E. Kajita
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  11. M. Hamada
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  13. K. Tomioka
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  14. N. Okamoto
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  15. N. Kurumatani
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Correspondence to M. Iki.

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Iki, M., Fujita, Y., Tamaki, J. et al. Incident fracture associated with increased risk of mortality even after adjusting for frailty status in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Osteoporos Int 28, 871–880 (2017). https://doi.org/10.1007/s00198-016-3797-y

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