# Association Between Possible Sarcopenia and Fracture Risk Assessment Tool (FRAX)-Estimated Fracture Risk Without Bone Mineral Density in Institutionalized Older Adults: A Cross-Sectional Study

## TL;DR

This study found no significant link between possible sarcopenia and fracture risk in institutionalized older adults using the FRAX tool.

## Contribution

The study provides new evidence on the lack of association between sarcopenia and fracture risk in institutionalized older adults using FRAX without bone density.

## Key findings

- Most participants (93.5%) were classified as having possible sarcopenia.
- Fracture risk was predominantly low (80.6% of participants).
- No significant association was found between sarcopenia and fracture risk (p=0.791).

## Abstract

Background

Musculoskeletal problems in the elderly pose a significant challenge for healthcare providers, as they constitute a vulnerable group. Fractures are often undetected, leading to a reduced quality of life due to increased disability, morbidity, and mortality. Therefore, early detection and intervention are essential to prevent fractures in the elderly. Sarcopenia is a contributing factor, as it affects postural instability, decreased balance, and increases the risk of falls. However, the association between possible sarcopenia and fracture risk in the elderly remains uncertain.

Methods

This analytical observational study used a cross-sectional design. This study was conducted in October 2025. A total of 96 older adults in Panti Sosial Tresna Werdha (PSTW) Budi Mulia 2 were selected using consecutive sampling. Fracture risk was assessed using the Fracture Risk Assessment Tool (FRAX) questionnaire. Possible sarcopenia status was measured using handgrip strength based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Data were analyzed using univariate and bivariate analysis with the Fisher-Freeman-Halton exact test, with a significance level of p<0.05.

Results

The mean age of the respondents was 69.7±7.5 years; 87 respondents were categorized as possible sarcopenia (93.5%), while six respondents (6.5%) had no possible sarcopenia. Fracture risk assessment showed that 75 respondents were in the low-risk category (80.6%). Statistical analysis yielded a p-value of 0.791, indicating no significant relationship between possible sarcopenia and fracture risk in older adults at PSTW Budi Mulia 2.

Conclusion

Among institutionalized older adults, most participants were classified as having possible sarcopenia, while fracture risk assessed using the FRAX tool was predominantly low. No significant association was observed between possible sarcopenia defined by handgrip strength and FRAX-estimated fracture risk.