The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density

Larsson, B. A. M.<sup>1</sup>; Johansson, L.<sup>1,2</sup>; Johansson, H.<sup>1,3</sup>; Axelsson, K. F.<sup>1,4</sup>; Harvey, N.<sup>5,6</sup>; Vandenput, L.<sup>3,7</sup>; Magnusson, P.<sup>8</sup>; McCloskey, E.<sup>9,10</sup>; Liu, E.<sup>3</sup>; Kanis, J. A.<sup>3,9</sup>; Sundh, D.<sup>1</sup>; Lorentzon, M.<sup>1,3,11</sup>

Affiliations

¹Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

²Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

³Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia

⁴Region Västra Götaland, Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden

⁵MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁶NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK

⁷Centre for Bone and Arthritis Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

⁸Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

⁹Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK

¹⁰MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK

¹¹Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, 43180 Mölndal, Sweden

Abstract and keywords

Summary: The timed up and go (TUG) test measures physical performance and predicts falls in the elderly. In older women, TUG time predicts the risk of major osteoporotic fracture and hip fracture independently of clinical risk factors and bone mineral density, and has a substantial impact on fracture probabilities.

Introduction: The timed up and go (TUG) test measures physical performance and predicts falls in the elderly. A slow TUG has been associated with an increased fracture risk, but it is unclear whether the association is independent of clinical risk factors and bone mineral density (BMD). The aim of this study was to investigate if TUG time was associated with fracture risk independently of clinical risk factors and BMD and to determine its impact on fracture probabilities in older women.

Methods: A standardized questionnaire was used to assess information regarding clinical risk factors in the large population-based SUPERB study of 3028 older women (75–80 years). At baseline, the TUG test was performed and BMD measured with DXA. The association between TUG time and the risk of hip fracture and major osteoporotic fracture (MOF) was examined using an extension of Poisson regression.

Results: Fracture incidence increased steeply with increasing TUG time up to 12 s and subsequently started to level off. A slow TUG time was therefore defined as TUG > 12 s, a cutoff level then used in Cox models to study the association between slow TUG and fracture risk. A slow TUG time was associated with an increased risk of fracture (MOF 2.39 [1.80–3.18] and hip fracture 2.96 [1.62–5.40]). These associations were slightly attenuated but remained significant after adjustment for clinical risk factors and femoral neck BMD. Depending on BMD, the 4-year fracture probability of MOF increased by a factor of 1.5–1.9 in a 75-year-old woman with slow TUG (> 12 s).

Conclusion: The TUG time predicts the risk of MOF and hip fracture independently of clinical risk factors and BMD and has a substantial impact on fracture probabilities, indicating that inclusion of the TUG test in patient evaluation should be considered in order to improve fracture prediction in older women.

Keywords: Clinical risk factors and bone mineral density; Fracture risk; The timed up and go test

Links

DOI: 10.1007/s00198-020-05681-w

PubMed: 33089354

WoS: 000582295900001

History

Received: 2020-06-17

Accepted: 2020-10-09

Online: 2020-10-21

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Cited By (4)

Year	Entry
2021	Kawada T. Physical performance test as a predictor of fracture risk. Bone. August 2021;149:116026.
2023	Alajlouni DA, Bliuc D, Tran TS, Blank RD, Center JR. Muscle strength and physical performance contribute to and improve fracture risk prediction in older people: a narrative review. Bone. July 2023;172:116755.
2023	Ucurum SG, Kirmizi M, Altas EU, Kaya DO. Sagittal spinal alignment and mobility and their relation to physical function in women with and without mild-to-moderate knee osteoarthritis. J Biomech. January 2023;146:111412.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Darelid A, Rudäng R, Sundh D, Litsne H, Johansson L, Lorentzon M. Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women. J Bone Miner Res. June 2023;38(6):860-868.