Decline in muscle strength and performance predicts fracture risk in elderly women and men.

Muscle strength and performance are associated with fractures. However, the contribution of their rate of decline is unclear.To assess the independent contribution of the rate of decline in muscle strength and performance to fracture risk.Community dwelling women (n=811) and men (n=440) aged 60+ from the prospective Dubbo Osteoporosis Epidemiology Study followed from 2000 to 2018 for incident fracture. Clinical data, appendicular lean mass/ht2, BMD, quadriceps strength/ht (QS), timed get-up-go (TGUG), sit-to-stand (5xSTS), and gait speed (GS) measured biennially. Rates of decline in muscle parameters were calculated using ordinal least square regression and fracture risk assessed using Cox's models.Incident low-trauma fracture ascertained by X-ray report.Apart from lean mass in women, all muscle parameters declined over time. Greater rates of decline in physical performance were associated with increased fracture risk in women (HRs ranging from 2.1 (95%CI:1.5-2.9) for GS to 2.7 (1.9-3.6) for 5xSTS) while in men, only the decline in GS was associated with fracture risk (HR: 3.4 (1.8-6.3)). Baseline performance and strength were also associated with increased fracture risk in men (HRs ranging from 1.8 (1.1-3.0) for QS to 2.5 (1.5-4.1) for TGUG) but not in women.Rate of decline in physical performance in both genders, and baseline strength and performance in men contributed independently to fracture risk. 5xSTS and GS were the tests most consistently associated with fractures. Further studies are required to determine whether muscle strength/performance improve the predictive accuracy of fracture prediction models.

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