Frailty as a Predictor of Future Fracture in Older Adults: A Systematic Review and Meta-Analysis

Background: Studies have identified frailty as an effective predictor of fracture; however, the correlation between frailty and fracture differs between various stages of frailty. Objectives: The main aim is to determine the correlation between various stages of frailty and fracture risk; a secondary purpose is to determine the correlation between subgroups (e.g., females, females with a hip fracture, or aged 65 years or older) within the stages of frailty and fracture risk. Finally, effect of frailty criteria on the association between stages of frailty and fracture risk was tested. Methods: We conducted a systematic review and meta-analysis. The inclusion criteria were as follows: (a) a prospective study design; (b) subjects aged 55 years or older; (c) a division into robust, prefrail, and frail groups; and (d) reported confidence intervals of hazard ratio. Two investigators independently assessed quality and discussed their findings to reach consensus. The quality of the literature was assessed and the level of evidence was also determined. Results: In total, five studies included 103,783 older people and recorded 2,960 fractures. The results identified that the risk of fracture in the frail people was higher than that in both the robust people (summary HR: 1.67; 95% CI [1.46-1.91]) and prefrail people (summary HR: 1.28; 95% CI [1.16-1.40], and that the risk of fracture in the prefrail people was higher than that in the robust people (summary HR: 1.30; 95% CI [1.20-1.41]). A subgroup analysis revealed that among female adults, older females with hip fracture, or those aged 65 years or more, those who were categorized as frail showed the highest fracture risk, followed by those who were categorized as prefrail. Linking Evidence to Action: Professional nurses caring for frail or prefrail people should actively develop fracture prevention measures to reduce the risk of death caused by fractures.