Fractures are a common health concern among the elderly population, often resulting in significant health complications.
Walking is now recognized as an activity preferred by the elderly, which is accessible to all, can be adapted to individual physical conditions, and whose health benefits are well documented. Walking speed and duration are also recognized health markers. A new study, carried out by a team from the Garvan Institute of Medical Research in Australia, shows that walking ability is an accurate marker of fracture risk in elderly patients.
The study explores a new approach to assessing fracture risk by examining the link between walking ability and the likelihood of fractures in older adults.
A simple question from a family doctor such as “Can you walk a kilometer?” says a lot about the future risk of fracture, summarizes lead author Jacqueline Centre, a professor at the Garvan Institute. For example, simply asking a patient about their potential walking limitations can help identify patients who need further bone health assessment and/or request further investigations and interventions.
The study analyzed data from 267,000 adults aged 45 and over who participated in the Sax Institute’s 45 and Up Study, a cohort that has been tracking adult health outcomes for more than 15 years. Participants were asked about their ability to walk various distances, with response options including “not at all”, “a little” or “completely”. The researchers recorded cases of bone fractures during a 5-year follow-up period. The analysis revealed that :
- 1 in 5 adults aged 45 and over reported walking limitations on admission.
- Participants with the most severe gait limitations were significantly more likely to suffer a fracture during the follow-up period.
- Women with severe limitations in their ability to walk one kilometer have a 60% higher risk of fracture compared to women of the same age without limitations.
- In men, the risk is increased by more than 100%.
- The association is distance-dependent, with a greater reduction in walking ability associated with a greater risk of fracture.
- 60% of all fractures recorded are due to some degree of inability to walk.
- These correlations also apply after taking into account the various possible confounding factors, such as age, history of falls and fractures, and body weight.
- The results are consistent for different fracture sites, such as hips, vertebrae, arms, and legs.
“The study’s lead author, Professor Jacqueline Centre, director of Garvan’s Clinical Trials and Epidemiology Laboratory, concludes: “Asking a few simple questions about how far a person can walk can give doctors an early warning sign and prompt them to check their bone health”.
Another important finding: among these generally healthy participants, the analysis revealed that one in five had difficulty walking one kilometer. These individuals could benefit significantly from bone density screening or preventive treatment.
This is because there are osteoporosis medications, lifestyle changes, and other interventions available to improve bone strength and prevent initial or recurrent fractures.
The assessment of fracture risk is usually based on a bone density test, which many people never do… The difficulty of walking, even short distances, which seems to be closely related to the risk of fracture, is an incentive to do this screening.
In conclusion, this study highlights the vital role of assessing walking ability as a simple yet effective means of identifying fracture risk in the elderly. By integrating this practice into healthcare, we can proactively address bone health and reduce the burden of fractures in aging populations.
Bliuc D, Tran T, Alarkawi D, et al. Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults. JAMA Netw Open. 2024;7(1):e2352675. https://doi.org/10.1001/jamanetworkopen.2023.52675