title: Physical Functioning Among Women Aged 80 Years and Older With Previous Fracture.
abstract: BACKGROUND
  The oldest old are the fastest growing segment of the elderly population. Little is known regarding the associations of fracture history with physical functioning assessed after age 80.
  
  
  METHODS
  Among 33,386 women surviving to age 80 years (mean ± SD years 84.6 ± 3.4), we examined the relationship between history of incident fracture after entry into the Women's Health Initiative (follow-up 15.2 ± 1.3 years) and their physical functioning assessed using the RAND-36 instrument most proximal to 2012 end of follow-up.
  
  
  RESULTS
  Baseline mean (±SD) physical function score was 82 (± 18). After adjustment for demographic and medical characteristics, fracture at each site, including hip, upper limb, lower limb, and central body, was associated with significantly lower subsequent physical functioning (all p < .001). Hip, upper leg, spine, and pelvis fractures were particularly related with lower physical functioning scores, 11.7 (95% CI: 10.3, 13.1), 10.5 (8.8, 12.3), 9.8 (8.9, 10.8), and 8.7 (7.2, 10.2) units lower, respectively, compared with women without fracture (each p < .0001). Compared with women without central site fracture, women with central site fractures also had lower physical functioning scores (10.0 [9.3, 10.8] units lower]; p < .0001). In case-only analysis of fractures, older age, less than 1 year since fracture, one or more additional sites fractured, history of cardiovascular disease or cancer, higher body mass index, and no alcohol intake in the past 3 months also were independent predictors of lower physical functioning score (all p < .05).
  
  
  CONCLUSIONS
  Among women surviving to 80 years and older, prior fracture is associated with lower current physical functioning, regardless of anatomical site of fracture, independent of other major predictors of disability.
authors: Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles. ccrandall@mednet.ucla.edu.
authors: Carolyn J
authors: CJ
authors: Crandall
authors: Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York.
authors: Michael J
authors: MJ
authors: LaMonte
authors: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors: Beverly M
authors: BM
authors: Snively
authors: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors: Meryl S
authors: MS
authors: LeBoff
authors: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
authors: Jane A
authors: JA
authors: Cauley
authors: Department of Medicine, University of Alabama, Birmingham.
authors: Cora E
authors: CE
authors: Lewis
authors: Department of Epidemiology, University of Iowa.
authors: Robert
authors: R
authors: Wallace
authors: Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester.
authors: Wenjun
authors: W
authors: Li
authors: Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson.
authors: Zhao
authors: Z
authors: Chen
authors: Department of Medicine, Center for Healthcare Policy and Research, UC Davis Medical Center, Sacramento, California.
authors: John A
authors: JA
authors: Robbins
authors: Department of Epidemiology and Environmental Health, University at Buffalo, the State University of New York.
authors: Jean
authors: J
authors: Wactawski-Wende
mesh_terms: D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology*; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D011788:Quality of Life; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D016387:Women's Health
keywords: Fracture; Frailty; Physical function