Fragility fractures impose a substantial global public health burden, driven by diminished bone strength and extrinsic risk factors. Frailty, characterized by multisystem decline and reduced physiological reserve, is increasingly recognized as a predictor of adverse outcomes. However, evidence linking frailty to fragility fractures and mortality in nationally representative samples remains limited. This mixed study combined cross-sectional analysis of fragility fractures with prospective mortality assessment in 14,752 NHANES participants (1999–2018). Survey-weighted multivariable logistic regression evaluated frailty and fragility fracture associations, and Cox proportional hazards models assessed mortality risk among participants with fragility fractures. Nonlinear analysis, subgroup analysis, and sensitivity analysis were also performed to validate the robustness of the results. After adjusting for covariates, logistic regression identified that each 0.1-unit Frailty Index increase was associated with 28% higher fragility fracture risk (OR 1.28, 95% CI 1.15–1.43) and 44% greater all-cause mortality of participants with fragility fractures (HR 1.44, 95% CI 1.25–1.65). Frail individuals had 66% elevated fragility fracture risk (OR1.66, 95% CI 1.27–2.17) and 110% increased mortality (HR 2.10, 95% CI 1.60–2.74) than non-frail individuals. Analysis of specific sites showed strong associations between frailty with hip fragility fractures (OR 2.49, 95% CI 1.44–4.33) and spinal fragility fractures (OR 2.24, 95% CI 1.21–4.13). The robustness of the results was validated using restricted cubic splines, subgroup analyses, and datasets with missing covariates removed. In conclusion, frailty is independently associated with a higher prevalence of fragility fractures and predicts mortality in American adults, demonstrating dose-response relationships and site-specific heterogeneity. Further research is needed to confirm these associations.
Dong et al. (Wed,) studied this question.