Dataset Information

Surgical Menopause and Frailty Risk in Community-Dwelling Older Women: Study of Osteoporotic Fractures.

ABSTRACT: OBJECTIVES:To determine whether women with surgical menopause have a higher risk of frailty than naturally menopausal women. DESIGN:Prospective cohort study with up to 18 years of follow-up. SETTING:Four U.S clinical centers. PARTICIPANTS:Community-dwelling white women aged 65 and older (mean 71.2±5.2) enrolled in the Study of Osteoporotic Fractures (N=7,699). MEASUREMENTS:Surgical menopause was based on participant self-report of having undergone bilateral oophorectomy before menopause. The outcome was incident frailty, classified as robust, prefrail, frail, or death at 4 follow-up interviews, conducted 6 to 18 years after baseline. Information on baseline serum total testosterone concentrations was available for 541 participants. RESULTS:At baseline, 12.6% reported surgical menopause. Over the follow-up period, 22.0% died, and 10.1% were classified as frail, 39.7% as prefrail, and 28.3% as robust. Surgically menopausal women had significantly lower total serum testosterone levels (13.2 ± 7.8 ng/dL) than naturally menopausal women (21.7 ± 14.8 ng/dL) (p=0.000), although they were not at greater risk of frailty (adjusted odds ratio (aOR)=0.94, 95% confidence interval (CI)=0.72-1.22), prefrailty (aOR=0.96, 95% CI=0.80-1.10), or death (aOR=1.17, 95% CI=0.97-1.42) after adjusting for age, body mass index, and number of instrumental activity of daily living impairments. There was no evidence that oral estrogen use modified these associations. CONCLUSION:In postmenopausal women, surgical menopause was not associated with greater risk for frailty than natural menopause, even in the absence of estrogen therapy. Future prospective studies are needed to investigate hormonal mechanisms involved in development of frailty in older postmenopausal women. J Am Geriatr Soc 66:2172-2177, 2018.

SUBMITTER: Huang G

PROVIDER: S-EPMC6292428 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Surgical Menopause and Frailty Risk in Community-Dwelling Older Women: Study of Osteoporotic Fractures.

Huang Grace G Coviello Andrea A LaValley Michael P MP Ensrud Kristine E KE Cauley Jane A JA Cawthon Peggy M PM Fredman Lisa L

Journal of the American Geriatrics Society 20180924 11

<h4>Objectives</h4>To determine whether women with surgical menopause have a higher risk of frailty than naturally menopausal women.<h4>Design</h4>Prospective cohort study with up to 18 years of follow-up.<h4>Setting</h4>Four U.S clinical centers.<h4>Participants</h4>Community-dwelling white women aged 65 and older (mean 71.2±5.2) enrolled in the Study of Osteoporotic Fractures (N=7,699).<h4>Measurements</h4>Surgical menopause was based on participant self-report of having undergone bilateral oo ...[more]

PMID: 30251302

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Project description:Frailty reflects an accelerated health decline. Frailty is a consequence of fracture and contributes to fracture. Greater frailty was associated with higher fracture risk. Frail women were at immediate risk (within 24 months) of a hip or major fracture. Fracture prevention could be improved by considering frailty status.IntroductionFrailty encompasses the functional decline in multiple systems, particularly the musculoskeletal system. Frailty can be a consequence of and contribute to fracture, leading to a cycle of further fractures and greater frailty. This study investigates this association, specifically time frames for risk, associated fracture types, and how grade of frailty affects risk.MethodsThe study is performed in the OPRA cohort of 1044, 75-year-old women. A frailty index was created at baseline and 5 and 10 years. Women were categorized as frail or nonfrail and in quartiles (Q1 least frail; Q4 most frail). Fracture risk was assessed over short (1 and 2 years) and long terms (5 and 10 years). Fracture risk was defined for any fracture, major osteoporotic fractures (MOFs), and hip and vertebral fracture, using models including bone mineral density (BMD) and death as a competing risk.ResultsFor women aged 75, frailty was associated with higher risk of fracture within 2 years (Hip SHRadj. 3.16 (1.34-7.47)) and MOF (2 years SHRadj. 1.88 (1.12-3.16)). The increased risk continued for up to 5 years (Hip SHRadj. 2.02 (1.07-3.82)); (MOF SHRadj. 1.43 (0.99-2.05)). Grade of frailty was associated with increased 10-year probability of fracture (p = 0.03). Frailty predicted fracture independently of BMD. For women aged 80, frailty was similarly associated with fracture.ConclusionFrail elderly women are at immediate risk of fracture, regardless of bone density and continue to be at risk over subsequent years compared to identically aged nonfrail women. Incorporating regular frailty assessment into fracture management could improve identification of women at high fracture risk.

Project description:So far, it has not yet been studied whether socioeconomic status is associated with distinct frailty components and for which frailty component this association is the strongest. We aimed to examine the association between socioeconomic status and frailty and frailty components. In addition we assessed the mediating effect of the number of morbidities on the association between socioeconomic status and other frailty components.This is a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet in the Netherlands among community-dwelling persons aged 55 years and older (n = 26,014). Frailty was measured with a validated Frailty Index that consisted of 45 items. The Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL (IADL), health-related quality of life, psychosocial health and self-rated health. Socioeconomic indicators used were education level and neighbourhood socioeconomic status.Persons with primary or secondary education had higher overall frailty and frailty component scores compared to persons with tertiary education (P < .001). Lower education levels were most consistently associated with higher overall frailty, more morbidities and worse self-rated health (P < .05 in all age groups). The strongest association was found between primary education and low psychosocial health for persons aged 55-69 years and more IADL limitations for persons aged 80+ years. Associations between neighborhood socioeconomic status and frailty (components) also showed inequalities, although less strong. The number of morbidities moderately to strongly mediated the association between socioeconomic indicators and other frailty components.There are socioeconomic inequalities in frailty and frailty components. Inequalities in frailty, number of morbidities and self-rated health are most consistent across age groups. The number of morbidities a person has play an important role in explaining socioeconomic inequalities in frailty and should be taken into account in the management of frailty.

Dataset Information

Surgical Menopause and Frailty Risk in Community-Dwelling Older Women: Study of Osteoporotic Fractures.

Publications

Surgical Menopause and Frailty Risk in Community-Dwelling Older Women: Study of Osteoporotic Fractures.

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