Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Did your competent? doctor get you walking far enough to prevent this? Or don't you have a functioning stroke doctor?

Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

Dana Bliuc, PhD^1,2,3; Thach Tran, PhD^1,4; Dunia Alarkawi, MPH, MHM^1,4; et al Weiwen Chen, PhD¹; Dima A. Alajlouni, MScMed^1,4; Fiona Blyth, PhD⁵; Lyn March, PhD⁶; Robert D. Blank, PhD¹; Jacqueline R. Center, PhD^1,4

Author Affiliations Article Information

JAMA Netw Open. 2024;7(1):e2352675. doi:10.1001/jamanetworkopen.2023.52675

Key Points

Question  Are adults aged 45 years and older with a walking ability limitation at a higher fracture risk compared with same-age adults without a walking limitation?

Findings  In this cohort study with 238 969 persons, 1 in 5 reported a limitation in walking 1000 m or less. Walking limitation was significantly associated with between a 32% and 219% higher fracture risk and contributed to approximately 60% of fractures.

Meaning  In this study, self-reported walking limitations were common; given that they are easily detected, they should be sought by clinicians to identify high-risk candidates for further bone assessment.

Abstract

Importance  The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated.

Objective  To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture.

Design, Setting, and Participants  This prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023.

Exposure  Self-reported walking limitation.

Main Outcomes and Measures  Incident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures).

Results  Among the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase.

Conclusions and Relevance  In this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.(NO, NO, NO! You blithering idiots need to provide protocols that solve this! ASSESSMENTS DO FUCKING NOTHING FOR RECOVERY!