We proposed the term “dysmobility syndrome” (DS) to identify individuals with impaired musculoskeletal health, a risk factor for falls and fractures. Whether DS is associated with increased risk of incident fracture is unknown. The Osteoporotic Fractures in Men (MrOS) study enrolled 5994 men ages ≥65 years, between March 2000 and April 2002. We used baseline data to determine whether DS increased fracture risk, independent of the Fracture Risk Assessment Tool (FRAX). Men met DS criteria at baseline if they had three or more of the following: appendicular lean mass/height 2 <7.26 kg/m 2 , total body fat >30%, spine or hip T-score ≤ –2.5, grip strength <30 kg, gait speed <1.0 m/s, and one or more fall within 12 months. We examined whether baseline DS increased the risk of hip and major osteoporotic fractures (MOFs) over a median of 14 years (IQR, 9 to 15 years). Among 5834 men mean age 74 ± 6 years, 471 (8%) had DS and 635 (11%) experienced an MOF, including 274 (5%) hip fractures. Age (per SD increase) conferred an HR of 1.72 (95% CI, 1.59 to 1.86), DS conferred an HR of 3.45 (95% CI, 2.78 to 4.29) and FRAX calculated with BMD (per %) conferred an HR of 1.10 (95% CI, 1.08 to 1.11) for MOF. Prediction of MOF using the FRAX score provided a concordance value of 0.67 ± 0.012 (concordance values are mean ± SE). Concordance increased to 0.69 ± 0.012 by adding DS and to 0.70 ± 0.012 by adding DS and age to the multivariate model. Kaplan-Meier curves indicated that men with both DS and a FRAX risk above the National Osteoporosis Foundation (NOF) treatment thresholds had higher MOF (HR 6.23; 95% CI, 3.10 to 12.54) and hip (HR 7.73; 95% CI, 5.95 to 10.04) fracture risk than men with neither condition. We suggest further studies to determine the optimal criteria for DS, and to test DS as a predictor of falls and fractures, especially in women.
Bibliographical noteFunding Information:
No authors had any conflict of interest regarding the work under consideration for publication. Outside of the submitted work the authors report the following: BB received grant support from Kinemed and the Extendicare Foundation, consultancy fees from GE/Lunar and Lilly, payment for development for educational presentations from Clinical Care Options, payment for lectures from AANS, and travel support from UCB and Janssen. SRC received consulting fees from Radius and Amgen. NEL received consulting fees from Amgen, Radius, Novartis, and Roche. NB received consultancy fees from Amgen, Radius, and Viking and grant funding from Novartis and Viking. KEE served as a consultant on a Data Monitoring Committee for Merck, Sharpe, & Dohme. Authors KEH, BLL, and PMC do not report any conflict of interest outside of the submitted work.
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health (NIH) funding. The following NIH institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. We thank the MrOS Publications Committee, particularly Sheena Patel, for their thorough review and valuable feedback of the manuscript, statistical analysis, and results. We thank Nicholas S. Keuler, Associate Faculty in the Statistics Department within the University of Wisconsin College of Letters and Sciences, for reviewing our statistical analyses.
- DYSMOBILITY SYNDROME