Butterfly effect of oral frailty and sensory blurring: A complex systems framework for hip fracture vulnerability

Table 1 Integrated multi-domain systemic prevention program for hip fracture vulnerability

Target system domain	Pathophysiological target/mechanism	Proposed intervention modality	Clinical/biomarker targets for evaluation
Oral systemic node	Occlusal loss (Eichner B/C), reduced masticatory force, tongue muscle atrophy	Prosthetic occlusal restoration. Daily tongue-pressure resistance training (e.g., iowa oral performance instrument). Deglutition training	Maximum tongue pressure ≥ 21.6 kPa. Eichner occlusal stabilization. Masticatory performance scores
Neurosensory & balance node	DPIS decline, sensory blurring, delayed feedforward postural control	Dual-task balance training. Perturbation-based reactive step training. Proprioceptive sensory sharpening exercises (e.g., Tai Chi)	Conditioned pain modulation response. Dynamic posturography sway velocity. Compensatory stepping latency
Nutritional & metabolic node	Anabolic resistance, protein-energy malnutrition, osteosarcopenia	High-protein supplementation (1.2-1.5 g/kg/day). Essential amino acids/Leucine fortification. Vitamin D3 & calcium supplementation	Serum albumin & prealbumin. 25-hydroxyvitamin D levels. Appendicular skeletal muscle mass index
Socio-inflammatory node	Hypothalamic-pituitary-adrenal axis hyperactivity, inflammaging (IL-6, TNF-α), isolation-induced immobility	Social prescribing (group dining, community exercise classes). Cognitive Behavioral Therapy for social anxiety/isolation	Serum CRP, IL-6, and cortisol ratios. UCLA loneliness scale score. Daily physical activity step counts

kPa: Kilopascals; UCLA: University of California Los Angeles; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-alpha; CRP: C-reactive protein.