Abstract
BACKGROUND: Osteoporotic fractures (OPF) represent a significant health concern among the elderly population. Frailty, a prevalent condition in this demographic, can be evaluated via the Frailty Index (FI). This study investigated the association between FI and all-cause mortality (ACM) in aged individuals with osteoporosis (OP). METHODS: This retrospective cohort study included 19,332 patients who underwent surgical treatment for fractures at Kunshan First People's Hospital between January 1, 2017, and August 31, 2023. Among these, 4,782 patients aged ≥ 50 years were diagnosed with OPF. The FI was developed based on 30 health indicators, and it requires the availability of at least 75% of the variables for all patients. Moreover, ACM was monitored from the time of hospitalization until death or the end of the study period. Data on the correlation between FI and ACM were statistically evaluated, including the Cox proportional hazard regression model, interaction test, smooth curve fitting, K-M survival curve, threshold effect, subgroup, and sensitivity analyses. RESULTS: Among the 3,833 patients, the mean age was 68.77 years, with an average FI of 0.07. A substantial positive correlation was observed between FI and ACM (HR = 1.05, 95% CI: 1.03-1.07, p < 0.01). Importantly, a 0.033 increase in the FI score (equivalent to ~ 1 additional cumulative deficit) was related to a 17% higher risk of ACM (HR: 1.17, 95% CI: 1.10 to 1.24). Subgroup analyses further validated these findings across diverse demographic groups. CONCLUSION: This study establishes a significant correlation between the FI and ACM in elderly patients with OPF, underscoring the importance of frailty measurement in clinical management. These findings support the need for targeted interventions to improve outcomes in this high-risk population and emphasize the necessity of further research to develop effective screening and management strategies.