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

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.