Osteoporosis International · Nov 4, 2026
Intrinsic capacity is associated with fracture risk in older women with osteoporosis
By Oliveri C, Surace F, Morabito N et al.
Intrinsic Capacity integrates physical and mental reserves that shape vulnerability during ageing. In postmenopausal women, impairments across multiple intrinsic capacity domains are associated with higher fracture risk. Intrinsic capacity assessment may support a function-centred approach to fracture risk stratification, providing complementary information beyond densitometric classification. Background Fragility fractures represent a major public health challenge. The World Health Organization (WHO) has introduced the Intrinsic Capacity (IC) framework, defined as the composite of an individual’s physical and mental capacities, as a multidimensional indicator of functional health in older adults. Aims To investigate the association between IC and fracture risk. Methods Postmenopausal women attending an outpatient clinic for osteo-metabolic disorders were consecutively enrolled. The five IC domains—cognition, locomotion, vitality, psychological well-being, and sensory function—were assessed using the Mini-Cog, Short Physical Performance Battery, Mini Nutritional Assessment, Patient Health Questionnaire-9, WHO eye chart, and digits-in-noise hearing test. 10-year fracture risk was calculated using FRAX. Bone mineral density (BMD) was assessed by Dual-Energy X-ray Absorptiometry (DXA). Results A total of 200 women (mean age 68.1 ± 8.6 years) were enrolled, of whom 195 (97.5%) exhibited impairment in more than one IC domain. A higher number of impaired IC domains correlated with an increased 10-year probability of major osteoporotic fractures (r = 0.392, p < 0.001). Preserved vision was independently associated with a lower prevalence of fragility fractures (OR = 0.2545; 95% CI 0.0693–0.9349). High estimated fracture risk was independently associated with hearing loss (OR = 2.3908; 95% CI 1.2689–4.5046), malnutrition (OR = 4.0114; 95% CI 1.5091–10.6630), and limited mobility (OR = 2.7898; 95% CI 1.4650–5.3127). Limited mobility was also associated with lower lumbar spine BMD (T-score < –2.5 SD) (OR = 0.4370; 95% CI 0.2416–0.7904). Conclusions Lower IC was associated with a higher estimated risk of fragility fractures in postmenopausal women, supporting the potential value of IC as a complementary component of fracture risk assessment in older adults.