Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study

Abstract

BackgroundThe Late‐Stage Elderly Questionnaire has been incorporated into health assessments for older adults in Japan, encompassing three self‐administered questions on subjective physical function: subjective gait speed decline, recent fall history, and exercise habits. Nevertheless, its efficacy in predicting new fracture occurrences remains uncertain.MethodsThis retrospective cohort study utilized Japan's DeSC database, a large commercially available claims database. Participants were older adults aged ≥75 years and provided complete responses to the Late‐Stage Elderly Questionnaire at health check‐ups. We performed two Cox regression analyses for new fractures based on the responses to the three questions (Model 1) and on age, sex, and responses to the three questions (Model 2). The predictive abilities of the 1‐year occurrence of new fractures were compared between the two models.ResultsOf 11 683 eligible older adults, 927 (7.93%) experienced new fractures. Model 1 revealed significant associations between new fractures and subjective gait speed decline (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40–1.89), recent fall history (HR, 2.03; 95% CI, 1.77–2.33), and absence of exercise habits (HR, 1.29; 95% CI, 1.13–1.47). Model 2 demonstrated superior predictive ability (area under the curve, 0.677; 95% CI, 0.659–0.695) compared with Model 1 (area under the curve, 0.633; 95% CI, 0.614–0.652), with a net reclassification improvement of 0.383 (95% CI, 0.317–0.449).ConclusionThree subjective physical well‐being factors were significantly associated with new fracture development in older adults. These results suggest that the three‐question assessment may be a valuable screening tool for identifying new fractures. Geriatr Gerontol Int 2024; ••: ••–••.

Reply to: Comments on “Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study”

“…We appreciate the comments by Togashi et al 1 on our article. 2 In response, we provide further information and perspectives on these points. First, our study's primary focus was to evaluate the predictive ability of the three items related to subjective physical function, because it remains unclear whether these three items are associated with the occurrence of new fractures.…”

“…Second, as mentioned in the limitations of our study, past and new fractures were not clearly distinguished. 2 Thus, we conducted a Cox regression analysis similar to the main analyses wherein participants with past fractures or osteoporosis were excluded. The results showed new fractures were associated with subjective gait speed decline (hazard ratio 1.55, 95% confidence interval [CI] 1.11-2.17), recent fall history (hazard ratio 1.39, 95% CI 0.97-2.00) and the absence of exercise habits (HR 1.28, 95% CI 0.93-1.76).…”

“…These results were consistent with those of the main analyses, although the CIs were wider because of the smaller sample size. 2 Third, the database lacks traceability of individuals before and after their subscription to the Late Older Medical Service System. However, this lack of traceability was not significant in our study.…”

“…

levels than those without chronic kidney disease. 2 In contrast, higher glycated hemoglobin levels can precipitate a more rapid decline in kidney function irrespective of baseline chronic kidney disease or diabetes status. 3 Lower grip strength frequently coexists with sarcopenia, leading to low serum creatinine levels and deviations in eGFR levels.

…”

Comments on “Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study”

“…Comments on "Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study" Dear Editor, We read a recently published article by Sato et al 1 with great interest. The authors reported the association of responses to three questions in the Late-Stage Older adults Questionnaire at health check-ups with the incidence of new bone fractures within 1 year among older adults aged ≥75 years using the DeSC database.…”