Frailty and bone health in European men

Research output: Contribution to journalArticle


Background: frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health.Methods: men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre.Results: in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P< 0.05). Similar results were seen using the FI after categorisation into 'high', 'medium' and 'low' levels of frailty. Using the Fried categorisation, frail men had lower femoral neck bone mineral density (BMD) compared to robust men (P < 0.05), but not lower lumbar spine BMD. Using the FI categorisation, a 'high' level of frailty (FI > 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05).Conclusions: optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people.


  • Michael J. Cook
  • Alexander Oldroyd
  • Stephen R Pye
  • Kate A Ward
  • Evelien Gielen
  • Rathi Ravindrarajah
  • Judith E Adams
  • David M Lee
  • Gyorgy Bartfai
  • Steven Boonen
  • Felipe Casanueva
  • Gianni Forti
  • Aleksander Giwercman
  • Thang S Han
  • Ilpo T. Huhtaniemi
  • Krzysztof Kula
  • Michael E. Lean
  • Neil Pendleton
  • Margus Punab
  • Dirk Vanderschueren
  • Frederick C Wu
  • Terence W. O'Neill
  • Luisa Petrone
  • Antonio Cilotti
  • Herman Borghs
  • Jolanta Slowikowska-Hilczer
  • Renata Walczak-Jedrzejowska
  • Ilpo Huhtaniemi
  • Frederick Cw Wu
  • Alan Silman
  • Terence O'Neill
  • Joseph D Finn
  • Philip Steer
  • Abdelouahid Tajar
  • David Lee
  • Stephen Pye
  • Marta Ocampo
  • Mary Lage
  • Imre Földesi
  • Imre Fejes
  • Paul Korrovitz
  • Min Jiang
  • EMAS Study Group
External organisations
  • University of Manchester
  • Great Ormond Street Hospital
  • MRC Human Nutrition Research
  • Catholic University of Leuven
  • King's College London
  • University of Szeged
  • CIBER de Fisiopatología Obesidad y Nutricion (CIBEROBN)
  • University of Florence
  • Royal Holloway University of London
  • Imperial College London
  • Medical University of Lodz
  • University of Glasgow
  • Tartu University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics
  • Geriatrics


  • bone mineral density, Frailty, heel ultrasound, male health, older people
Original languageEnglish
Article numberafw205
Pages (from-to)635-641
Number of pages7
JournalAge and Ageing
Issue number4
Publication statusPublished - 2017 Jul 1
Publication categoryResearch