Longitudinal study finds link between musculoskeletal health and frailty

A new study by Dr Monica Tembo from the Epi-Centre for Healthy Ageing in IMPACT’s Population Health team has uncovered how musculoskeletal health can predict frailty in older adults.   

The longitudinal study commenced all the way back in 2001 as part of the Geelong Osteoporosis Study. The study involved 287 men aged 50 years and older who were followed up again more than 15 years later in 2016-2019.   

“The longitudinal study design provides evidence for temporal relationships between exposures and outcomes that cannot be inferred from a cross-sectional study,” Dr Tembo said.  

“The challenge with this study design is that it takes many years to follow participants over a sufficient time to monitor the outcome of interest.”   

According to the Victorian Department of Health, frailty is a multidimensional geriatric syndrome characterised by a decline of physical and cognitive reserves that leads to increased vulnerability. Frailty increases with age and is associated with falls, longer stays in hospital, difficulty recovering from illness and surgery, and mortality.  

Australia’s population is ageing, with older Australians making up a growing proportion of the total population. In 2017, more than 1 in 7 people were aged 65 and over. This proportion is projected to grow steadily over the coming decades.   

“With an ageing population, it has become paramount to address conditions that affect older adults, which includes frailty, as these conditions increase the burden already existent in the healthcare system,”

Dr Monica Tembo  

Musculoskeletal factors and frailty  

However, few longitudinal studies have investigated the association between musculoskeletal factors and the trajectory to frailty.   

The study found that low muscle mass and strength as well as low bone mass and quality were strong predictors for frailty.   

“Lifestyle factors including age, weight, smoking, alcohol use and physical activity also contributed to the prediction model, however the addition of musculoskeletal parameters improved the model substantially,” Dr Tembo said.  

Lower physical activity levels and sedentary behaviour were associated with higher risk for frailty. The team also found an association between other behaviours such as alcohol consumption and smoking.   

“These findings were expected but we quantified the actual contribution of musculoskeletal factors in general, and separate bone and muscle parameters in particular, to ascertain which conferred a greater contribution and predictability,” Dr Tembo said.  

The research also discovered that muscle deficits accounted for a greater proportion of the risk for frailty than bone deficits.  

“This highlights the need for more interventions that particularly maintain muscle health and function during ageing,” Dr Tembo said.  

What if we could predict frailty?  

This research highlights how musculoskeletal health could be a potential target in preventing and managing frailty in older adults. This could reduce the risk of falls, poor mobility, loss of independence and the chances of ending up in hospital.   

“This research can impact on our community by designing interventions that would improve musculoskeletal health such as targeted exercise regimes, and dietary changes that improve muscle and bone health,” Dr Tembo said.   

Dr Tembo hopes to see future research continue around frailty, this time with a focus on women.  

“Future research in the female cohort of the Geelong Osteoporosis Study is planned, and will add to this knowledge base,” Dr Tembo said. “Also of importance is to replicate this study using other frailty assessment tools that would further validate our findings.” 

Details of Dr Tembo’s recent publication can be found at: https://rdcu.be/b4FOm