# Association between physical function parameters and fracture risk in older women in primary health care in southern Brazil

## TL;DR

This study finds that simple physical measures like handgrip strength and calf circumference can help identify older women at higher risk of fractures.

## Contribution

The study identifies handgrip strength and calf circumference as low-cost indicators for fracture risk in older women.

## Key findings

- Reduced handgrip strength, calf circumference, and lean mass were associated with higher fracture risk.
- ALMI showed the strongest association with high fracture risk in older women.
- Simple physical measures can complement conventional assessments like DXA and FRAX in primary care.

## Abstract

Simple functional measures may help identify older women at high fracture risk. In this cross-sectional study, reduced handgrip strength, calf circumference, and lean mass were associated with higher risk of fracture by FRAX. These easily obtainable parameters may enhance fracture-risk screening in primary care.

To examine the associations between frailty, sarcopenia-related parameters, and fracture risk in community-dwelling older women, and to evaluate whether simple functional measures may help identify individuals at elevated risk of osteoporotic fractures.

We conducted a cross-sectional study including women aged ≥ 60 years recruited from a primary care facility in Southern Brazil. Frailty was assessed using the Clinical Frailty Scale, and muscle strength and physical performance were evaluated using SARC-F, Timed Up and Go, gait speed, the Short Physical Performance Battery, calf circumference (CC), and handgrip strength (HGS). Bone mineral density and trabecular bone score (TBS) were measured by DXA. Ten-year fracture probability was estimated using the Brazilian FRAX® algorithm. Appendicular lean mass index (ALMI) and biochemical markers relevant to bone metabolism were also analyzed.

Among the 119 participants, 38.5% were classified as having high or very high 10-year fracture risk. Compared with women in the low-risk group, those at high risk were older and had lower BMI, TBS, HGS, CC, and ALMI, in addition to a higher comorbidity burden. In multivariable Poisson regression adjusted for age and comorbidity, lower muscle strength, reduced muscle mass, and poorer physical performance were independently associated with higher fracture risk prevalence, whereas frailty status was not. Among the muscle parameters, ALMI showed the strongest association with high fracture risk.

Reduced muscle strength and lean mass were associated with higher fracture risk, even in women without established frailty or sarcopenia. HGS and CC emerge as simple, low-cost indicators that may enhance fracture-risk screening in primary care and complement conventional assessments such as DXA and FRAX.