Adults Who Cite Walking Difficulty Face Higher Fracture Risk

Self-reported walking limitations among middle-age and older adults were predictive of future fracture risk, according to a prospective cohort study in Australia.

Among men and women age 45 and over, those who reported “a lot” of limitation walking 1 km had up to a twofold higher risk of fracture over 5 years compared with those who said they had no limitations (HR 2.03, 95% CI 1.86-2.22 for men; HR 1.60, 95% CI 1.49-1.71 for women), reported Dana Bliuc, PhD, of the Garvan Institute of Medical Research in Darlinghurst, and colleagues.

Even those who said they had “a little” bit of walking limitation had a significantly higher 5-year incident fracture risk (HR 1.46, 95% CI 1.34-1.60 for men; HR 1.32, 95% CI 1.23-1.41 for women), they wrote in JAMA Network Open.

Bliuc told MedPage Today these findings offer clinicians one straightforward question to ask patients that may help identify patients at high risk of fracture: How difficult is walking 1 km?

“This question presents an opportunity to identify patients for further evaluation or preventive measures that is readily incorporated into primary care without adding to the burden frontline clinicians face,” she explained.

“Given that fracture risk is not currently screened at the population level, the study underscores the potential of employing walking ability, an easily recorded question, to proactively identify individuals at high risk of fracture,” she continued. “Even reporting ‘a little’ walking limitation was associated with increased fracture risk, underscoring the impact walking ability assessment could have on the early identification of high-risk candidates for prompt intervention.”

Overall, about 60% of the fractures that were identified during the average 4.1-year follow-up were deemed attributable to walking limitation, which “emphasiz[es] its substantial impact on fracture risk identification at a population level,” said Bliuc. Out of the 238,969 individuals included, 7,190 women and 4,267 men experienced an incident fracture. This equated to rates of 11.92 fractures per 1,000 person-years for women and 7.93 fractures per 1,000 person-years for men.

The researchers also quantified the association between fracture risk with certain site-specific fractures, including hip, vertebral, and non-hip nonvertebral fractures. The strongest association was with hip fracture, with men who had a lot of walking limitations having more than a threefold higher risk for a fracture at this site (HR 3.34, 95% CI 2.76-4.03). But overall, both men and women with any degree of walking limitation had a significantly higher risk for fracture at any of these three sites.

Adults ages 45 and older (average age 61) from an Australian Medicare enrollment database were recruited for the study from 2005 through 2008. After study enrollment, participants were asked three questions about if their health limited them in walking 1 km, 0.5 km, or 100 meters, in which they could answer “not limited at all,” “limited a little,” or “limited a lot.” Around 24% of women and 21% of men reported some degree of walking limitation for 1,000 meters or less, which Bliuc called the most surprising finding of the study.

“One in five participants over the age of 45 reported some degree of walking difficulty for 1 km or less,” she said. “This was not expected, because the New South Wales [Sax Institute] 45 and Up cohort is relatively healthy.”

A little less surprising was that walking limitations significantly increased with age. Among women, those with no, a little, or a lot of walking limitations had average ages of 59, 66, and 71, respectively. For men, these average ages were 62, 68, and 72. The percentage of adults who had a fall also significantly increased with walking limitations:

• None: 15.7% of women and 9.5% of men had a fall
• A little: 29.5% of women and 23.8% of men had a fall
• A lot: 40.5% of women and 38% of men had a fall

“The potential for improving a person’s walking ability is encouraging,” Bliuc reassured. “Demonstrating through interventional studies that improving walking ability has a beneficial impact on bone health would be a motivator for patients to take early action for better long-term health.”

“Furthermore, it would highlight the utility of nonpharmacological treatments,” she added. “A lot of patients are reluctant to take effective fracture-preventing drugs. These findings reinforce the message that even without drugs, fracture risk can be reduced.”

Study limitations included the fact that walking ability was not objectively measured and the lack of information on cognitive function and mood disorders, both of which could impact the perception of walking ability.

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