Back Pain and Prospective Frailty Status Among Older Men: Findings From the MrOS Study

The association between back pain and frailty is uncertain. This study examined the association between back pain in older men and prospective frailty status an average of 7 years later.

Prospective cohort study using data from the Osteoporotic Fractures in Men Study. Eligible participants were men who, at study Visit 3 (Year 7), completed a back pain assessment (presence, frequency, severity, activity limitation) and a phenotypic frailty assessment (robust, pre-frail, frail). Among men classified as either robust or pre-frail, phenotypic frailty was again assessed at Visit 4 (Year 14), with deaths between Visits 3 and 4 considered a separate terminal outcome category. The association of Visit 3 back pain with frailty phenotype relative to a robust (and pre-frail) status at Visit 4 was analyzed using multivariable-adjusted multinominal logistic regression models.

Among 5994 men enrolled, 2554 men who were considered robust or pre-frail at Visit 3 (mean [SD] age = 71.6 [4.9] years) were included in the current analysis. After accounting for age, study clinic site, race and education, presence of any back pain, moderate-severe severity, high frequency, and activity limiting back pain were prospectively associated with higher odds of being frail vs. robust and of being frail vs. pre-frail an average of 7 years later. However, after adjustment for other characteristics including prefrail vs. robust status at Visit 3, only the activity-limiting back pain phenotype was associated with significantly higher odds of later being classified as frail vs. prefrail (OR = 1.40 [1.03-1.90]), and no back pain phenotypes were associated with higher odds of later being classified as frail vs. robust.

Among older community-dwelling men, back pain, particularly activity-limiting back pain, was associated with higher odds of progression to frailty during a 7-year period, suggesting that back pain may be a modifiable risk factor for age-related phenotypic frailty. Further replication and understanding of the mechanisms underpinning the relationship between back pain and frailty are needed to inform targeted interventions in older individuals at risk of frailty.