Beyond static frailty: longitudinal trajectories, nonlinear associations, and muscle strength mediation in osteoporosis risk.
7 affiliations
- 1Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China.
- 2Provincial Clinical Research Center for Rheumatic and Immunologic Diseases, Xiangya Hospital, Changsha, China.
- 3Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.
- 4National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
- 5Hunan Yueya Dental Clinic, Changsha, China.
- 6Changsha Chang Hao Hospital, Changsha, China.
- 7Department of Emergency, Xiangya Hospital, Central South University, Changsha, China.
Abstract
Background
Frailty, a multidimensional indicator of declining physiological reserve, has been consistently linked to adverse health outcomes. However, whether dynamic trajectories of the Frailty Index (FI) predict new-onset osteoporosis remains unclear.Methods
For this longitudinal cohort study, we retrieved data on adults aged ≥50 years from the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe. We assessed frailty using the FI and identified longitudinal frailty trajectories, examined associations of baseline FI and frailty trajectories with incident osteoporosis, and explored nonlinear relationships and the potential mediating role of grip strength.Results
Over median follow-up periods of 4, 6, and 8 years, 244, 2,693, and 1,986 participants in the ELSA, the SHARE, and the HRS cohorts developed osteoporosis, respectively. Higher baseline FI was independently associated with greater osteoporosis risk across all cohorts, with adjusted hazard ratios of 1.43 (95% confidence interval (CI) = 1.36-1.50, P < 0.001) in the HRS, 1.36 (95% CI = 1.19-1.57, P < 0.001) in the ELSA, and 1.39 (95% CI = 1.33-1.45, P < 0.001) in the SHARE cohort. We identified four FI trajectories. Compared with the low frailty group, participants in higher frailty trajectory groups generally exhibited increased risks of osteoporosis across cohorts. Nonlinear analyses pointed to threshold effects in the HRS and the SHARE, with steeper risk increases at lower FI levels. Grip strength partially mediated this association.Conclusions
In our sample, baseline FI and its longitudinal trajectories were significantly associated with osteoporosis. Our findings suggest that the early identification and monitoring of frailty, as well as muscle strength improvement, may help reduce osteoporosis risk.
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BibTeX
@article{zhou2026beyond,
title = {{Beyond static frailty: longitudinal trajectories, nonlinear associations, and muscle strength mediation in osteoporosis risk.}},
author = {Junyu Zhou and Jui-Hua Wang and Zhen Huang and Liping Cao},
journal = {Journal of global health},
year = {2026},
month = oct,
doi = {10.7189/jogh.16.04320},
url = {https://europepmc.org/article/MED/42895262},
note = {CC BY},
}
RIS
TY - JOUR
TI - Beyond static frailty: longitudinal trajectories, nonlinear associations, and muscle strength mediation in osteoporosis risk.
AU - Junyu Zhou
AU - Jui-Hua Wang
AU - Zhen Huang
AU - Liping Cao
PY - 2026
DA - 2026/10/19
JO - Journal of global health
DO - 10.7189/jogh.16.04320
UR - https://europepmc.org/article/MED/42895262
AB - Background Frailty, a multidimensional indicator of declining physiological reserve, has been consistently linked to adverse health outcomes. However, whether dynamic trajectories of the Frailty Index (FI) predict new-onset osteoporosis remains unclear.Methods For this longitudinal cohort study, we retrieved data on adults aged ≥50 years from the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing and Retirement in Europe. We assessed frailty using the FI and identified longitudinal frailty trajectories, examined associations of baseline FI and frailty trajectories with incident osteoporosis, and explored nonlinear relationships and the potential mediating role of grip strength.Results Over median follow-up periods of 4, 6, and 8 years, 244, 2,693, and 1,986 participants in the ELSA, the SHARE, and the HRS cohorts developed osteoporosis, respectively. Higher baseline FI was independently associated with greater osteoporosis risk across all cohorts, with adjusted hazard ratios of 1.43 (95% confidence interval (CI) = 1.36-1.50, P < 0.001) in the HRS, 1.36 (95% CI = 1.19-1.57, P < 0.001) in the ELSA, and 1.39 (95% CI = 1.33-1.45, P < 0.001) in the SHARE cohort. We identified four FI trajectories. Compared with the low frailty group, participants in higher frailty trajectory groups generally exhibited increased risks of osteoporosis across cohorts. Nonlinear analyses pointed to threshold effects in the HRS and the SHARE, with steeper risk increases at lower FI levels. Grip strength partially mediated this association.Conclusions In our sample, baseline FI and its longitudinal trajectories were significantly associated with osteoporosis. Our findings suggest that the early identification and monitoring of frailty, as well as muscle strength improvement, may help reduce osteoporosis risk.
SN - 2047-2978
SN - 2047-2986
ER -