Researchers at the Garvan Institute of Medical Research and UNSW Sydney have unveiled a straightforward yet significant indicator of fracture risk in older adults: the ability to comfortably walk one kilometre.
The groundbreaking results, disclosed in JAMA Network Open, propose that investigating walking limitations could serve as an early alert for clinicians, prompting prompt bone health screening and interventions to prevent fractures.
Lead author of the study, UNSW Medicine & Health Conjoint Professor Jacqueline Center, who leads Garvan’s Clinical Studies and Epidemiology Lab, explains “We’ve discovered that trouble walking even short distances appears closely tied to higher fracture risk over the following five years.”
“Just a few simple questions about how far someone can walk could give doctors an early warning sign to check bone health,” Center explained.
The study found that one in five adults reported some walking limitation at the study’s commencement. Those facing more challenges in walking were notably more likely to experience a fracture during the follow-up period. Women reporting significant limitations in walking one kilometre had a notable 60 per cent higher fracture risk, while for men, the risk surged over 100 per cent.
“We saw a clear ‘dose-response’ pattern, where greater walking limitation meant higher fracture risk. This suggests a direct relationship between low walking ability and weaker bones,” says first author of the study Dr Dana Bliuc, Senior Lecturer at UNSW Medicine & Health and Senior Research Officer at Garvan.
Surprisingly, approximately 60 per cent of all fractures in the study were associated with some degree of walking limitation. This connection persisted even after accounting for factors such as age, falls, prior fractures, and weight. The findings remained consistent across various fracture sites, including hips, vertebrae, arms, and legs.
“In this generally healthy community-based population, we still found one in five people had trouble walking a kilometre,” Center said.
“We think this simple assessment could help identify many more at-risk individuals who may benefit from bone density screening or preventative treatment.”
Osteoporosis medications, lifestyle changes, and other interventions are available to improve bone strength and avoid first or repeat fractures. However, screening rates currently remain low, meaning many miss out on fracture risk assessments. Finding easy but accurate ways to detect at-risk people is an important target for research.
“Fracture risk assessment generally relies on a bone density test, which many people have not had when seeing their doctor,” Center said.
“Asking about walking ability takes just seconds and could be a free, non-invasive way to tell if someone needs their bones checked.”
The researchers acknowledge that walking limitations may have various causes beyond weak bones, such as heart disease or arthritis. However, the study underscores that difficulty walking even short distances is closely tied to fracture risk independently.
“We hope these findings will encourage clinicians to consider walking ability as a red flag for possible bone health issues. For patients, if you can’t walk a full kilometre comfortably, it may be wise to ask your doctor about getting your bones checked,” Bliuc said.
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