Just one look, and fractures and death can be predicted in elderly ambulatory women

The chronological age is clearly the strongest risk factor for fractures or death. Age as a concept can be described exactly as chronological age. Age in relative terms can be described as biological age.

We postulated that, even without taking into account known or unknown comorbidity, an immediate and totally subjective evaluation of an individual's biological age is predictive of forthcoming fractures and death.

At baseline the biological age was estimated in 1,004 randomly recruited ambulatory 75-year-old women. All women were of the same ethnic background. Two independent observers estimated the biological age within 15 s of first sight of each woman. Based on this estimation of the biological age, the women were divided into tertiles. The women were then followed prospectively for a mean of 4.6 (range 3.0-6.5) years. All retrospective fractures and prospective fractures and deaths were registered.

When the tertile of the biologically oldest women was compared with all other women, their odds ratio for sustaining any type of prospective fracture was 1.71 (95% confidence interval 1.22-2.39), for hip fractures 2.69 (1.42-5.11), for clinical vertebral fractures 2.83 (1.57-5.11), and for multiple fractures 3.17 (1.64-6.10). Also, when retrospectively sustained fractures were included, the predictive ability for biological age remained. The death rate amongst the tertile of biologically oldest women was increased when compared with the rest of the women (odds ratio 4.33, CI 3.62-5.17).

In ambulatory elderly women, without specific consideration of comorbidity, a subjective estimate of the biological age is predictive of future fractures and death. Subjective estimation of the biological age, in relation to the chronological age, is a valuable indicator of health, conveying additional information that merits its use in clinical practice.