Abstract
BACKGROUND: As population aging intensifies, osteoporosis has emerged as a critical public health concern in China, substantially impacting the health and well-being of older adults. Osteoporosis not only diminishes health-related quality of life in late life but also contributes to increased healthcare expenditures and societal burdens. In older adults with osteoporosis, frailty and fear of falling are prevalent and interrelated conditions that further impair health-related quality of life. Addressing frailty and fear of falling in this population may significantly improve health-related quality of life outcomes. However, limited research has examined how both frailty and fear of falling, independently and interactively, affect health-related quality of life in older adults with osteoporosis in China. METHODS: Data were collected from 209 older adults with osteoporosis using structured questionnaires. Multiple linear regression analysis was conducted to examine the independent effects of frailty and fear of falling on health-related quality of life, as well as their interaction effect, while controlling for potential confounders, including age, daily exercise duration, history of falls in the past year, and number of chronic conditions. RESULTS: Multiple linear regression analysis identified significant associations between health-related quality of life and factors including age, daily exercise duration, history of falls in the past year, number of chronic conditions, frailty, and fear of falling. Frailty and fear of falling independently impacted health-related quality of life, with their interaction further intensifying the decline in health-related quality of life [B = 8.763, SE = 2.028, 95% CI (4.763, 12.763), P < 0.001]. Compared to participants who were non-frail and had no fear of falling, those who were frail and had high levels of fear of falling reported significantly lower health-related quality of life [B = 16.218, SE = 2.735, 95% CI (10.820, 21.611), P < 0.001]. CONCLUSION: Frailty and fear of falling exert significant and interactive effects on health-related quality of life in older adults with osteoporosis. The findings underscore the need for comprehensive, multidimensional interventions targeting both frailty and fear of falling to improve health-related quality of life and promote successful aging in this vulnerable population.