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.; Johansson, L.; Johansson, H.; Axelsson, K. F.; Harvey, N.; Vandenput, L.; Magnusson, P.; McCloskey, E.; Liu, E.; Kanis, J. A.; Sundh, D.; Lorentzon, M.

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

Cited Works (11)

Year	Entry
1999	Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. March 13, 1999;353(9156):878-882.
2019	Kanis JA, Cooper C, Rizzoli R, Reginster J-Y; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO); Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. January 2019;30(1):3-44.
2016	Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV; The Advisory Board of the National Osteoporosis Guideline Group. A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. December 2016;11(1):25.
1999	Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. June 1999;94(446):496-509.
2000	Kanis JA, Glüer C-C; Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. March 2000;11(3):192-202.
1998	Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468-489.
2006	Sambrook P, Cooper C. Osteoporosis. Lancet. June 17, 2006;367(9527):2010-2018.
2008	Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int. April 2008;19(4):385-397.
2005	Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int. June 2005;16(6):581-589.
2004	Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey E, Mellstrom D, Melton L, Pols H, Reeve J, Silman A, Tenenhouse A. A meta-analysis of previous fracture and subsequent fracture risk. Bone. August 2004;35(2):375-382.
1991	Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. February 1991;39(2):142-148.

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.