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23 Jan 2024

Walking fitness can predict fracture risk in older adults

Can you walk a kilometre? The answer can reveal clues about your future fracture risk.

Emeritus Professor Robert Blank, Professor Jacqueline Center and Dr Dana Bliuc
Emeritus Professor Robert Blank, Professor Jacqueline Center and Dr Dana Bliuc

The ability to walk one kilometre comfortably can help predict fracture risk, according to researchers at the Garvan Institute of Medical Research. The findings, published today in JAMA Network Open, suggest that simply asking a patient about walking limitation could allow clinicians to identify those in need of further bone health screening and prescribe interventions that could prevent fractures from occurring.

“We’ve discovered that trouble walking even short distances appears closely tied to higher fracture risk over the following five years,” says lead author of the study, Professor Jacqueline Center, Head of Garvan’s Clinical Studies and Epidemiology Lab. “Just a few simple questions about how far someone can walk could give doctors an early warning sign to check bone health.”

The researchers examined data on nearly 267,000 adults aged 45 and older from the Sax Institute’s 45 and Up Study, a major ongoing research initiative that has been tracking health outcomes in adults in NSW for more than 15 years. Participants were asked if health issues limited their ability to walk various distances, with answer options of ‘not at all,’ ‘a little,’ or ‘a lot’. The group was then followed for five years to track fracture outcomes.

The researchers found that one in five adults reported some walking limitation at the beginning of the study. Those with more difficulty walking were significantly more likely to experience a fracture during follow-up. For example, women who said they were limited ‘a lot’ in walking one kilometre had a 60% higher fracture risk than women with no limitation. For men, the increased risk was over 100%.

“We saw a clear ‘dose-response’ pattern, where greater walking limitation meant higher fracture risk. This suggests a direct relationship between low walking ability and weaker bones,” says first author of the study Dr Dana Bliuc, Senior Research Officer at Garvan.

Approximately 60% of all fractures in the study were attributable to some level of walking limitation. The link remained strong even after accounting for other factors like age, falls, prior fractures, and weight, and the findings were consistent across different fracture sites like hips, vertebrae, arms, and legs.

A new way to boost bone density screening rates

“In this generally healthy community-based population, we still found one in five people had trouble walking a kilometre,” says Professor Center. “We think this simple assessment could help identify many more at-risk individuals who may benefit from bone density screening or preventative treatment.”

“Fracture risk is not something that should be taken lightly. There is increased mortality following fractures at most sites, as well as increased risk of suffering a subsequent fracture or of being admitted to the hospital for any reason. It has much more severe consequences for an adult to suffer a fracture than for a child,” says Emeritus Professor Robert Blank, Senior Research Officer at Garvan.

Osteoporosis medications, lifestyle changes, and other interventions are available to improve bone strength and avoid first or repeat fractures. However, screening rates currently remain low, meaning many miss out on fracture risk assessments. Finding easy but accurate ways to detect at-risk people is an important target for research.

“Fracture risk assessment generally relies on a bone density test, which many people have not had when seeing their doctor,” says Professor Center. “Asking about walking ability takes just seconds and could be a free, non-invasive way to tell if someone needs their bones checked.”

The researchers stress that walking limitation may have many causes beyond weak bones, from heart disease to arthritis. However, a difficulty in walking even short distances appears closely tied to fracture risk independently.

“We hope these findings will encourage clinicians to consider walking ability as a red flag for possible bone health issues. For patients, if you can’t walk a full kilometre comfortably, it may be wise to ask your doctor about getting your bones checked,” says Dr Bliuc.

This research was supported by a National Health & Medical Research Council grant (APP 1108886 to JRC), a Medical Research Future Fund (1137462 to JRC), and Mrs Janice Gibson and Ernest Heine Family Foundation.

Professor Jacqueline Center is a Conjoint Professor at St Vincent's Clinical School, Faculty of Medicine and Health, UNSW Sydney. Dr Dana Bliuc is a Senior Lecturer at the School of Population Health, Faculty of Medicine and Health, UNSW Sydney.