Accumulating Fragility Fractures Associate with Worsening Physical Capability and Self-Rated Health in Postmenopausal Women: A 20-Year Cohort Study

Background: Individuals with fragility fractures typically show reduced functional status and lowered quality of life, but there is limited information on the role of accumulating fractures over longer follow-up time. This study examined the longitudinal association between the cumulative fragility fractures and self-reported physical capability (PC) and self-rated health (SRH) over a 20-year period in 6,612 older women.

Methods: The 25-year questionnaire responders in the population-based Kuopio osteoporosis and risk-factor prevention (OSTPRE) study were selected as a base population for whom PC and SRH data were available from the earlier questionnaires. The cumulative number of fractures of the wrist, hip, ankle, humerus, and spine was assessed, with PC and SRH recorded at 10-year intervals from 1994 (baseline) to 2014 (endpoint). Associations with cumulative fracture count and PC/SRH were assessed with descriptive analyses and with longitudinal regression models for ordinal responses that were estimated with generalized estimating equations (GEE).

Results: Women in the no-fracture group consistently reported higher PC and SRH at all time points. At baseline, 93.9% of women without fractures reported good PC, with a 14.9 percentage point (pp) decline over 20 years; in comparison, declines were 19.5 pp, 16.2 pp, and 19.2 pp for those with one, two, and three or more fractures, respectively. Baseline SRH was similarly lower among women with fractures. The prevalence of good SRH at baseline was 47.9% in the no-fracture group, declining by 5.2 pp by the endpoint; corresponding declines for the one, two, and three or more fracture groups were 5.3 pp, 10.1 pp, and 3.2 pp. GEE analyses confirmed associations between cumulative fracture burden and worse PC and SRH after full adjustment, with comorbidity burden emerging as the strongest independent predictor of both outcomes.

Conclusion: Women with fractures demonstrated consistently lower PC and SRH throughout the 20-year follow-up, with the greatest reductions observed in those with multiple fractures. Mitigating comorbidity burden and prioritizing fracture prevention may be essential strategies to maintain physical capability and self-rated health in aging populations.