Physical Functioning Among Women Aged 80 Years and Older With Previous Fracture

Abstract

BACKGROUND: The oldest old are the fastest growing segment of the elderly population. Little is known regarding the associations of fracture history with physical functioning assessed after age 80. METHODS: Among 33,386 women surviving to age 80 years (mean +/- SD years 84.6 +/- 3.4), we examined the relationship between history of incident fracture after entry into the Women's Health Initiative (follow-up 15.2 +/- 1.3 years) and their physical functioning assessed using the RAND-36 instrument most proximal to 2012 end of follow-up. RESULTS: Baseline mean (+/-SD) physical function score was 82 (+/- 18). After adjustment for demographic and medical characteristics, fracture at each site, including hip, upper limb, lower limb, and central body, was associated with significantly lower subsequent physical functioning (all p < .001). Hip, upper leg, spine, and pelvis fractures were particularly related with lower physical functioning scores, 11.7 (95% CI: 10.3, 13.1), 10.5 (8.8, 12.3), 9.8 (8.9, 10.8), and 8.7 (7.2, 10.2) units lower, respectively, compared with women without fracture (each p < .0001). Compared with women without central site fracture, women with central site fractures also had lower physical functioning scores (10.0 [9.3, 10.8] units lower]; p < .0001). In case-only analysis of fractures, older age, less than 1 year since fracture, one or more additional sites fractured, history of cardiovascular disease or cancer, higher body mass index, and no alcohol intake in the past 3 months also were independent predictors of lower physical functioning score (all p < .05). CONCLUSIONS: Among women surviving to 80 years and older, prior fracture is associated with lower current physical functioning, regardless of anatomical site of fracture, independent of other major predictors of disability.