Change in frailty status before and after osteoporotic vertebral compression fractures in the elderly and associated factors

Abstract

Objectives: Frailty is a common geriatric syndrome that increases the risk of falls, fractures, and adverse outcomes. Osteoporotic vertebral compression fractures (OVCFs) may be both a consequence and an accelerator of frailty. This study aimed to evaluate changes in frailty status before and after OVCFs in older adults and to identify factors associated with frailty progression following the fracture. Methods: A cross-sectional study with longitudinal follow-up was conducted among 187 patients aged ≥60 years with new OVCFs, who were examined at the Rheumatology Outpatient Clinic, University Medical Center Ho Chi Minh City (Sep 2024–Jun 2025). Frailty was assessed using the Clinical Frailty Scale (CFS) at the time of the study and retrospectively for the pre-fracture period. Frailty was defined as CFS ≥5. Results: The prevalence of frailty (CFS ≥5) increased from 46.0% before the fracture to 62.0% at 3 months (McNemar χ² = 30.0; p < 0.001). No patient reverted from frail to non-frail. The median CFS increased from 4 (IQR 4–5) to 5 (IQR 4–6); 32.6% of patients experienced an increase of at least one point in CFS. In multivariable logistic regression analysis, prior falls (OR = 5.26; 95% CI: 2.65–10.44) and having ≥3 fractured vertebrae (OR = 3.08; 95% CI: 1.30–7.31) were significantly associated with increased CFS after VCFs. Conclusion: Osteoporotic vertebral compression fractures aggravate frailty in older adults, with a marked increase in frailty prevalence and no spontaneous recovery observed within 3 months. Prior falls and having three or more fractured vertebrae are important risk factors for frailty progression and should be addressed in comprehensive patient care.