title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Incident clinical fracture was associated with an elevated risk of death independently of pre-fracture levels of frailty in community-dwelling elderly men.
authors.affiliation: Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. masa@med.kindai.ac.jp.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-2128-5255
authors.initials: M
authors.lastname: Iki
authors.affiliation: Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Tamaki
authors.affiliation: Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kouda
authors.affiliation: Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yura
authors.affiliation: Department of Health and Nutrition, Faculty of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui, 915-8586, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Nursing, Faculty of Health Science, Kio University, 4-2-2 Umami-naka, Kita-Katsuragi-gun, Koryo-cho, Nara, 635-0832, Japan.
authors.forename: J S
authors.initials: JS
authors.lastname: Moon
authors.affiliation: Department of Orthopedics, Yamato-Takada Municipal Hospital, 1-1 Isonokitamachi, Yamato-Takada, Nara, 635-8501, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Harano
authors.affiliation: Department of Physical Therapy, Faculty of Biomedical Engineering, Osaka Electro-Communication University, 18-8 Hatsucho, Neyagawa, Osaka, 572-8530, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hazaki
authors.affiliation: 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.
authors.forename: E
authors.initials: E
authors.lastname: Kajita
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Hamada
authors.affiliation: 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.
authors.forename: K
authors.initials: K
authors.lastname: Arai
authors.affiliation: Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tomioka
authors.affiliation: Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kurumatani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016330:Frail Elderly / Q000706:statistics & numerical data; D000073496:Frailty / Q000401:mortality*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D010024:Osteoporosis / Q000401:mortality*; D058866:Osteoporotic Fractures / Q000401:mortality*; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods
keywords: Cohort study; Elderly Japanese men; Fracture; Frailty; Mortality; Physical performance