TOPLINE:

Older women with lower levels of serum albumin and a lower prognostic nutritional index (PNI) had an increased risk for fractures. Lower albumin levels were also linked to poorer physical function and higher risks for injurious falls and mortality.

METHODOLOGY:

• Researchers used data from a prospective cohort to assess whether serum albumin levels and a nutrition-related index were associated with a future risk for fractures and related outcomes in elderly women.
• They included 2966 Swedish women aged 75-80 years (mean age, 77.8 years); the women were followed up for a median duration of 8 years.
• Baseline assessments evaluated serum albumin levels and lymphocyte counts. PNI was calculated as the serum albumin level (g/L) plus five times the total lymphocyte count (×10⁹/L); women were grouped into quartiles according to albumin levels and PNI.
• Bone mineral density (BMD) was measured at the lumbar spine, total hip, and femoral neck, and bone microarchitecture was assessed at the ultradistal tibia. Physical function was evaluated using tests measuring 6-meter walking speed, chair stand performance, and hand grip strength.
• Incident fractures were verified through x-ray reports. Data on injurious falls and mortality were obtained from national registers.

TAKEAWAY:

• Each 1-SD decrease in albumin levels was associated with a 14% higher risk for major osteoporotic fractures, a 12% higher risk for any fracture, a 10% higher risk for injurious falls, and an 18% higher risk for mortality (P < .01 for all) after multiple adjustments.
• Each 1-SD decrease in PNI was associated with a 16% higher risk for major osteoporotic fractures and a 17% higher risk for any fracture (P ≤ .01 for both) after multiple adjustments.
• Women in the highest vs lowest quartile of albumin levels had 14.8% higher physical activity scores, 10.8% greater grip strength, 34.1% longer one‑leg standing time, 10.3% more chair stand repetitions, and 4.1% faster walking speed (P < .01 for all). Similar but weaker patterns were seen for PNI.
• Neither albumin levels nor PNI were associated with BMD at the lumbar spine, total hip, or femoral neck, and their associations with tibial microarchitecture were limited and inconsistent.

IN PRACTICE:

"[The study] findings suggest that albumin may serve as a valuable biomarker of frailty and fall risk, with potential utility in fracture risk prediction. Given the ageing population, a timely and cost-effective biomarker like albumin may be an invaluable tool for assessing frailty in older adults," the authors of the study wrote.

SOURCE:

The study was led by Raju Jaiswal and Berit A.M. Larsson, of University of Gothenburg, Gothenburg, Sweden. It was published online on April 02, 2026, in the Journal of Bone and Mineral Research.

LIMITATIONS:

Levels of albumin were assessed only at baseline and not at the time of fracture. The study included only Swedish women aged 75-80, limiting the generalizability of the findings. Albumin levels may have been affected by other illnesses that were not fully adjusted for in the analyses.

DISCLOSURES:

The authors did not report any funding source for the study. Four authors reported receiving lecture fees, personal fees, and/or consulting fees from multiple pharmaceutical and healthcare companies outside the scope of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.