Exploring the relationship between neighborhood walkability and fracture risk among older people in Japan

Osteoporosis can lead to an increased risk of fragility fractures, which are closely associated with substantial loss of function, morbidity, and mortality, particularly in older adults. While walkable neighborhoods are recognized as crucial features contributing to health aging, research exploring its specific association with fragility fractures remains limited, especially in the countries with high rates of aging populations. In this study, we examined the relationship between fracture outcomes and neighborhood built environment using a five-year period of fracture history data from 39,577 older adults (≥75 years old). Multivariate logistic regression models were performed to estimate the odds ratios of fracture outcome for each built environment attribute. Our findings offer new insights into urban planning strategies aimed at mitigating the risk of fragility fractures. Recommended strategies include: 1) prioritizing the creation of livable city with diverse destinations and facilitating easy access to public transportation; 2) the provision of cultural facilities, catering establishments, grocery stores, and drug stores, especially cultural facilities; 3) avoid establishing residences in high slope terrain areas.