Abstract
Gait speed, grip strength, and depression are common and often coexist in older adults, and their interaction may provide a comprehensive understanding of fracture risk. This study examined the individual and combined associations of slow gait, weak grip, and depressive symptoms with the risk of fractures in older adults. Sixteen thousand three hundred fifty-seven Australian participants aged ≥ 70 years from the ASPirin in Reducing Events in the Elderly (ASPREE) trial were included. Sub-distribution hazard ratios (sHR) and 95% confidence intervals (CI) were estimated using a multivariable-adjusted Fine–Gray model, accounting for death as a competing risk. The sHR for any fractures was 17% higher among participants with slow gait and 23% higher among those with depressive symptoms, while weak grip was not significantly associated. The co-occurrence of slow gait and weak grip was associated with a 23% higher risk of any fracture (sHR = 1.23; 95% CI 1.04–1.46). Slow gait combined with depressive symptoms was associated with a 46% higher risk of any fracture and a 64% higher risk of MOF (sHR = 1.46; 95% CI 1.06–2.01; sHR = 1.64; 95% CI 1.03–2.61, respectively). Weak grip combined with depressive symptoms was associated with a 47% higher risk of any fracture and a 57% higher risk of MOF (sHR = 1.47; 95% CI 1.08–2.00; sHR = 1.57; 95% CI 1.01–2.47, respectively). These associations were stronger among males and those with diabetes. The combination of slow gait with either weak grip or depressive symptoms was more strongly associated with fracture risk than each factor individually. These findings underscore the importance of incorporating physical function and mental health assessments in clinical evaluations of older adults. Graphical Abstract