Walking difficulty predicts higher fracture risk

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The ability to walk one kilometer comfortably can help predict fracture risk, according to researchers at the Garvan Institute of Medical Research. The findings, published today in JAMA Network Open, suggest that simply asking a patient about walking limitations could allow clinicians to identify those in need of further bone health screening and prescribe interventions that could prevent fractures from occurring.

We've discovered that trouble walking even short distances appears closely tied to higher fracture risk over the following five years. Just a few simple questions about how far someone can walk could give doctors an early warning sign to check bone health."

Professor Jacqueline Center, lead author of the study, Head of Garvan's Clinical Studies and Epidemiology Lab

The researchers examined data on nearly 267,000 adults aged 45 and older from the Sax Institute's 45 and Up Study, a major ongoing research initiative that has been tracking health outcomes in adults in NSW for more than 15 years. Participants were asked if health issues limited their ability to walk various distances, with answer options of 'not at all,' 'a little,' or 'a lot'. The group was then followed for five years to track fracture outcomes.

The researchers found that one in five adults reported some walking limitation at the beginning of the study. Those with more difficulty walking were significantly more likely to experience a fracture during follow-up. For example, women who said they were limited 'a lot' in walking one kilometer had a 60% higher fracture risk than women with no limitation. For men, the increased risk was over 100%.

We saw a clear 'dose-response' pattern, where greater walking limitation meant higher fracture risk. This suggests a direct relationship between low walking ability and weaker bones."

Dr Dana Bliuc, Senior Research Officer at Garvan, first author of the study

Approximately 60% of all fractures in the study were attributable to some level of walking limitation. The link remained strong even after accounting for other factors like age, falls, prior fractures, and weight, and the findings were consistent across different fracture sites like hips, vertebrae, arms, and legs.

"In this generally healthy community-based population, we still found one in five people had trouble walking a kilometer," says Professor Center. "We think this simple assessment could help identify many more at-risk individuals who may benefit from bone density screening or preventative treatment."

Osteoporosis medications, lifestyle changes, and other interventions are available to improve bone strength and avoid first or repeat fractures. However, screening rates currently remain low, meaning many miss out on fracture risk assessments. Finding easy but accurate ways to detect at-risk people is an important target for research.

"Fracture risk assessment generally relies on a bone density test, which many people have not had when seeing their doctor," says Professor Center. "Asking about walking ability takes just seconds and could be a free, non-invasive way to tell if someone needs their bones checked."

The researchers stress that walking limitation may have many causes beyond weak bones, from heart disease to arthritis. However, a difficulty in walking even short distances appears closely tied to fracture risk independently.

"We hope these findings will encourage clinicians to consider walking ability as a red flag for possible bone health issues. For patients, if you can't walk a full kilometer comfortably, it may be wise to ask your doctor about getting your bones checked," says Dr Bliuc.

Source:
Journal reference:

Bliuc, D., et al. (2024). Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.52675.

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