title: Frailty and bone health in European men.
abstract: frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health.
  
  
  
  men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre.
  
  
  
  in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P< 0.05). Similar results were seen using the FI after categorisation into 'high', 'medium' and 'low' levels of frailty. Using the Fried categorisation, frail men had lower femoral neck bone mineral density (BMD) compared to robust men (P < 0.05), but not lower lumbar spine BMD. Using the FI categorisation, a 'high' level of frailty (FI > 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05).
  
  
  
  optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cook
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Oldroyd
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.affiliation: MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Ward
authors.affiliation: Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Evelien
authors.initials: E
authors.lastname: Gielen
authors.affiliation: Primary Care & Public Health Services, King's College London, London, UK.
authors.forename: Rathi
authors.initials: R
authors.lastname: Ravindrarajah
authors.affiliation: Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Adams
authors.affiliation: Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, ManchesterM13 9PL, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.affiliation: Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary.
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Bartfai
authors.affiliation: University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.affiliation: Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III,Santiago de Compostela, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Casanueva
authors.affiliation: Endocrine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Sweden.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Egham & Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Institute of Cardiovascular Research, Royal Holloway, University of London (ICR2UL), Chertsey, UK.
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.affiliation: Department of Reproductive Biology, Imperial College London, London, UK.
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.affiliation: Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.affiliation: Human Nutrition, University of Glasgow, Glasgow, UK.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lean
authors.affiliation: Division of Neuroscience and Experimental Psychology, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.affiliation: Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Andrology Research Unit,Centre for Endocrinology and Diabetes,University of Manchester, Manchester,UK.
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Wu
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
mesh_terms: D015502:Absorptiometry, Photon; D000058:Accidental Falls; D000328:Adult; D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005060:Europe; D050723:Fractures, Bone / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D000073496:Frailty / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography
keywords: Frailty; bone mineral density; heel ultrasound; male health; older people