Self-assessed walking ability may help identify fracture risk in older adults

By Melanie Hinze

Patient self-assessment of walking ability could be used by clinicians to help identify older adults who may be at high risk of fracture, new research published in JAMA Network Open suggests.

The researchers conducted a prospective cohort study of 238,969 participants (53% women; mean age 63 years) from the Sax Institute 45 and Up Study, an ongoing study of healthy ageing in New South Wales, Australia. Participants were recruited between 2005 and 2008 and followed for five years. The study was designed to compare patients with various degrees of self-reported walking ability limitation at 1000m or less.

Participants were classified into the following three groups based on their self-assessed level of walking limitation: no limitation, a little limitation or a lot of limitation. Fracture risk was determined after accounting for age, falls, prior fractures and weight.

About 20% of participants reported some degree of limitation walking 1000 m or less at baseline. Over a mean of 4.1 years’ follow up, 7190 women and 4267 men experienced an incident fracture.

When compared with participants with no walking limitations, women with a little limitation had a 32% increased risk of fracture and men had a 46% increased risk. Women with a lot of limitation had a 60% greater risk of fracture whereas men with a lot of limitation had around double the risk of fracture.

Overall, the study authors found that 60% of fractures were attributed to a walking limitation.

‘Our study found that inquiring about a patient’s ability to walk a short distance of less than 1 km, can effectively identify those with an elevated risk of fracture,’ Dr Dana Bliuc, Senior Research Officer at the Garvan Institute of Medical Research, Sydney, and lead author told Medicine Today.

She said that this finding suggested that GPs could promptly identify patients at a higher risk and take further steps to prevent fractures.

‘Walking ability may serve as a general proxy for health, but this remains to be demonstrated in other contexts,’ she said.

‘Importantly, this simple approach could be easily integrated into practice, without adding to the high burden clinicians face,’ she added.

JAMA Netw Open 2024; 7(1): e2352675.