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To the Editor: As noted in our manuscript1 and outlined in the table included in the Appendix of the article, there are some differences between the components of modified Cardiovascular Health Study (CHS) index used in our analyses and the original CHS index2 developed by Fried and colleagues. As is the case with several other studies3–5 examining the predictive validity of the CHS index, some components were identical to those of the original CHS index, and others were similar. Our objective in developing the simple Study of Osteoporotic Fractures (SOF) index was to create an index of frailty appropriate for the busy clinical practice setting.

Dr. Filho and colleagues express two major concerns with our approach. The first concern is that use of the modified CHS may have affected our results regarding the performance of the more complex CHS versus that of the simple SOF index in predicting adverse health outcomes, but a recent prospective study6 in older adults compared adapted CHS (components of weight loss, poor energy/exhaustion, and slowness components defined identically to these components in CHS and components of weakness and low physical activity defined similar to these components in CHS) and SOF indexes. This study reported that the CHS and SOF indexes were good at distinguishing geriatric conditions and predicting adverse outcomes, including recurrent falls and overnight hospitalization. The authors concluded that, in comparison with the CHS index, the simpler SOF index may be easier and more practical to use in a clinical setting. Thus, it is unlikely that use of the modified CHS index had a major effect on our results regarding the comparison between CHS and SOF indexes.

In addition, Dr. Filho and colleagues express concern that the CHS and SOF indexes are limited to “sarcopenic” markers of frailty and do not indicate other important changes in physiological parameters such as changes in hormonal and immune systems that may underlie the syndrome of frailty. As we note in the discussion, although we compared the predictive ability of the SOF index with that of the widely referenced CHS index, several indexes of frailty have been proposed, and our findings are not generalizable across different frailty instruments. We agree with Dr. Filho and colleagues that future research on frailty indexes incorporating biological markers of frailty is warranted.

ACKNOWLEDGMENTS

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  2. ACKNOWLEDGMENTS
  3. REFERENCES

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Dr. Ensrud has received grant support from the National Institutes of Health (and supporting agencies) under Grants U01 AR45614 and R01 HL070847.

Author Contributions: Both authors shared in the writing of this letter.

Sponsor's Role: None.

REFERENCES

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  2. ACKNOWLEDGMENTS
  3. REFERENCES