The Relationship between Frailty and Osteoporosis in
Women over 70
Y. Oliel*, T. Resnick*, S. Sternberg**, J. Menczel***, & A. Woloski-Wruble*
* Hadassah and Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
** Maccabi Health Services, Jerusalem, Israel
*** Herzog Hospital, Jerusalem, Israel
Objective
Main Variables
To determine the relationship between osteoporosis and frailty
in Israeli women over the age of 70.
Methods and Materials
DESIGN: Descriptive correlational study.
SETTING: Community dwelling Israeli women.
INSTRUMENTS:
Frailty:
Cardiovascular Health Study (CHS) Index
(Fried et al., 2001)
Vulnerable Elders Survey (VES-13) Questionnaire
Osteoporosis
Frailty
• Diminished bone mass,
disruption of microscopic
bone structure, and bone
fragility.
• Prevalence in Israel - more
than 150 thousand women,
aged 65 years or older (Israel
Health Ministry, 2003)
• Sign of vulnerability and
may be a good marker for
frailty (Rolland et al., 2008)
• Connected to molecular
changes in the cells and
characterized by a
syndrome of shrinking
(sarcopenia and weight
loss), weakness, and
exhaustion.
• Prevalence: 10-25% of the
elderly; up to 45% in those
over 85 years of age
(Fried & Walston, 2003)
• The pre-frail are at high
risk of developing the full
frailty syndrome
(Saliba et al., 2001)
Osteoporosis: bone mineral density (BMD), measured by
dual energy X-ray absorptiometry (DXA)
(Fried et al., 2001)
Sample characteristics
• A convenience sample of women, from one of the health care
organizations
• N = 137
• Mean age - 76 years (range 70-95)
Osteoporosis in women
• Most reported good financial status
Cycle of Frailty
(Ahmed et al., 2006)
• Most reported 10th grade or higher education
• Average cognitive and functional status - at the upper limits
Results
Variable
n
Yes (%)
Pre-diagnosed osteoporosis
137 65 (47.4) 72 (52.6)
With osteoporosis, on medication 65
This study did not support a direct association between frailty
and osteoporosis, though it provides important insight into
the challenges related to conducting research with this age
group.
No (%)
35 (54.8) 30 (46.2)
Fell during previous year
137 42 (30.7) 95 (69.3)
Fracture during previous year
137 9 (6.6)
Almost half of the
subjects reported being
previously diagnosed
with osteoporosis.
128 (93.4)
VES-13
CHS Index
Normal
Frail
Total
Robust
47 (34.31%)
2 (1.46%)
49 (35.77%)
Pre-Frail
51 (37.23%)
22 (16.06%) 73 (53.28%)
Frail
3 (2.19%)
12 (8.76%)
Total
101 (73.72%)
36 (26.28%) 137 (100%)
15 (10.95%)
Discussion
A correlation of 0.61
(p<.01) was found
between the two scales
measuring frailty.
The suggestion of an association between frailty and
osteoporosis, which exists only after controlling for
Holocaust survival and the self-reported number of years
since start of menopause, may be worthwhile investigating
with a larger population sample allowing stratification by
these variables.
As noted in the literature (Iecovich & Carmel, 2010; Marcus &
Menczel, 2007), women who survived the Holocaust are at
increased risk for osteoporosis. The suggested connection
with frailty only strengthens the need for counseling and
follow-up of this group.
The present study is part of an ongoing longitudinal study
that attempts to follow older women and determine the
relationship between osteoporosis and frailty.
CHS Index
Osteoporosis
Robust
Pre-Frail
Frail
Total
17
26
9 (6.57%)
52
(12.41%)
(18.98%)
28
42
(20.44%)
Normal
Total
Status
Osteoporosis
Osteopenia
No direct association
was found between
frailty and osteoporosis.
(37.96%)
5
75
(30.66%)
(3.65%)
(54.74%)
4 (2.92%)
5 (3.65%)
1 (0.73%)
10 (7.30%)
49
73
15
137 (100%)
(35.77%)
(53.28%)
(10.95%)
VES-13
Osteoporosis Status Normal
Frail
Total
Osteoporosis
36 (26.28%)
16 (11.68%) 52 (37.96%)
Osteopenia
59 (43.07%)
16 (11.68%) 75 (54.74%)
Normal
6 (4.38%)
4 (2.92%)
Total
101 (73.72%) 36 (26.28%) 137 (100%)
10 (7.30%)
After adjusting for
Holocaust survival and selfreported number of years
since the start of
menopause,
it was found that the CHS
Index frail subjects, versus
the normal and pre-frail
subjects, had a fourfold
increase for the risk of
osteoporosis
(OR = 0.25, 95% CI [0.07,
0.91])
References
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