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This study aimed to evaluate frailty measures throughout the disease process.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective analysis measured frailty in MSD patients at multiple time points using a modified Metastatic Spinal Tumor Frailty Index (MSTFI). Scores were 0: \u201cnot frail,\u201d 1: \u201cmild\u201d, 2: \u201cmoderate, and \u2265\u20093: \u201csevere.\u201d Measurements were taken at cancer diagnosis, spine metastasis (SM) diagnosis, and 4-month intervals up to 2-years. The change in frailty distribution was described at the general cohort and patient levels. Two-year survival was assessed from baseline frailty status at SM diagnosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>This study included 465 patients with an average age of 62.3 years (\u00b1\u200912.7), 33.8% female. Prostate cancer was most common (20.9%), followed by renal cell carcinoma (15.3%), non-small cell lung cancer (NSCLC, 13.5%), and others. Frailty changed dynamically, most significantly early in the disease. Initially, 79.4% were not frail; this dropped to 60.1% at SM diagnosis and to 42.7% at 4 months. Patients with short-term (4 month) data showed rapid frailty progression, with 57% becoming moderately to severely frail (<jats:italic>p<\/jats:italic>\u2009=\u20090.01), whereas 45% with long-term (24 months) data remained non-frail (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Contributing factors included anemia (32.7%), electrolyte abnormalities (16.9%), and malnutrition (11.4%). Histological classification influenced frailty. Higher frailty scores at metastatic diagnosis correlated with worse 2-year survival outcomes (p: &lt;0.001\u20130.04), underscoring frailty\u2019s prognostic significance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Frailty is dynamic, with a potential early intervention point to maintain or reverse it. Further research is needed to assess which frailty measures are most dynamic and amenable to intervention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11060-025-05213-8","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T13:19:10Z","timestamp":1757423950000},"page":"1247-1259","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The dynamic nature of frailty in metastatic spine disease patients"],"prefix":"10.1007","volume":"175","author":[{"given":"Oludotun","family":"Ogunsola","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward S.","family":"Harake","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Albdewi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varun","family":"Kathawate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebele","family":"Ogunsola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikram","family":"Chakravarthy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Szerlip","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"5213_CR1","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","volume":"173","author":"K Rockwood","year":"2005","unstructured":"Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. 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