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Osteoporosis International

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Open Access 01-01-2018 | Original Article

Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women

Authors: Lisa Johansson, Daniel Sundh, Martin Nilsson, Dan Mellström, Mattias Lorentzon

Published in: Osteoporosis International | Issue 1/2018

Abstract

Summary

Studies investigating prevalent vertebral fracture (VF) diagnosed using densitometry-based VF assessment (VFA) and associations with physical function, assessed by performance-based measures, are lacking. In this population-based study of 1027 older women, we found that prevalent VF, identified by VFA, was associated with inferior physical health, back pain and inferior physical function.

Purpose

Several studies have investigated the associations between health-related quality of life (HRQL) and back pain with prevalent VF, detected by spine radiographs, but just a few have been population-based and have used vertebral fracture assessment (VFA) for diagnosing VF. The aims of this study were to investigate associations between prevalent VF, detected by VFA, with HRQL, back pain and physical function, and investigate if also mild VFs were associated with these clinical parameters.

Methods

One thousand twenty-seven women aged 75–80 years participated in this population-based cross-sectional study. VF was identified by VFA using dual-energy X-ray absorptiometry. HRQL was assessed by SF-12, back pain during the past 12 months using a questionnaire, and physical function was tested with one leg standing (OLS), Timed Up and Go (TUG), walking speed, 30-s chair stand test and maximum grip strength.

Results

Physical health (Physical Component Summary, PCS), derived from SF-12, was worse (43.5 ± 11.3 vs. 46.2 ± 10.5, p < 0.001) and back pain more frequent in women with any VF than in women without (69.0 vs. 59.9%, p = 0.008). PCS and physical function (OLS, 30-s chair stand test), were significantly worse for mild VF compared to no VF (43.8 ± 10.9 vs. 46.2 ± 10.5, p < 0.001, 12.7 ± 9.9 vs. 15.3 ± 10.4 s, p = 0.038, 10.7 ± 3.2 vs. 11.4 ± 3.4 times, p = 0.021, respectively). In multivariable adjusted linear regression models, VF prevalence was associated with PCS (β = − 0.079, p = 0.007), TUG (β = 0.067, p = 0.021), walking speed (β = − 0.071, p = 0.009) and 30-s chair stand test (β = − 0.075, p = 0.012).

Conclusions

In conclusion, prevalent VF, diagnosed by VFA, was associated with inferior physical health, back pain and inferior physical function, indicating VFA is useful for diagnosing clinically relevant vertebral fractures. Also, mild VF was associated with inferior physical health and inferior physical function.

Chrischilles EA, Butler CD, Davis CS, Wallace RB (1991) A model of lifetime osteoporosis impact. Arch Intern Med 151(10):2026–2032CrossRefPubMed

Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 7(2):221–227. https://doi.org/10.1002/jbmr.5650070214 CrossRefPubMed

Melton LJ 3rd, Lane AW, Cooper C, Eastell R, O'Fallon WM, Riggs BL (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3(3):113–119CrossRefPubMed

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. https://doi.org/10.1007/s00198-006-0172-4 CrossRefPubMed

O'Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in european men and women: the European vertebral osteoporosis study. J Bone Miner Res 11(7):1010–1018. https://doi.org/10.1002/jbmr.5650110719 CrossRefPubMed

Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women. Osteoporos Int 16(12):2175–2179. https://doi.org/10.1007/s00198-005-2023-0 CrossRefPubMed

Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O, European Vertebral Osteoporosis S (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European vertebral osteoporosis study. Osteoporos Int 14(1):61–68. https://doi.org/10.1007/s00198-002-1316-9 CrossRefPubMed

Nuti R, Caffarelli C, Guglielmi G, Gennari L, Gonnelli S (2014) Undiagnosed vertebral fractures influence quality of life in postmenopausal women with reduced ultrasound parameters. Clin Orthop Relat Res 472(7):2254–2261. https://doi.org/10.1007/s11999-014-3588-8 CrossRefPubMedPubMedCentral

Al-Sari UA, Tobias J, Clark E (2016) Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 27(10):2891–2900. https://doi.org/10.1007/s00198-016-3648-x CrossRefPubMed

10.

Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323CrossRefPubMed

11.

Melton LJ 3rd, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221CrossRefPubMed

12.

Genant HK, Li J, CY W, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3(3):281–290CrossRefPubMed

13.

Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11(8):660–668. https://doi.org/10.1007/s001980070063 CrossRefPubMed

14.

Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14(11):871–878. https://doi.org/10.1007/s00198-003-1461-9 CrossRefPubMed

15.

Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17(2):281–289. https://doi.org/10.1007/s00198-005-2010-5 CrossRefPubMed

16.

Domiciano DS, Figueiredo CP, Lopes JB, Kuroishi ME, Takayama L, Caparbo VF, Fuller P, Menezes PF, Scazufca M, Bonfa E, Pereira RM (2013) Vertebral fracture assessment by dual X-ray absorptiometry: a valid tool to detect vertebral fractures in community-dwelling older adults in a population-based survey. Arthritis Care Res 65(5):809–815. https://doi.org/10.1002/acr.21905 CrossRef

17.

Kanterewicz E, Puigoriol E, Garcia-Barrionuevo J, del Rio L, Casellas M, Peris P, Frodos Research G (2014) Prevalence of vertebral fractures and minor vertebral deformities evaluated by DXA-assisted vertebral fracture assessment (VFA) in a population-based study of postmenopausal women: the FRODOS study. Osteoporos Int 25(5):1455–1464. https://doi.org/10.1007/s00198-014-2628-2 PubMed

18.

Waterloo S, Sogaard AJ, Ahmed LA, Damsgard E, Morseth B, Emaus N (2013) Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007–08. BMC Geriatr 13:102. https://doi.org/10.1186/1471-2318-13-102 CrossRefPubMedPubMedCentral

19.

Giorgetti MM, Harris BA, Jette A (1998) Reliability of clinical balance outcome measures in the elderly. Physiother Res Int 3(4):274–283CrossRefPubMed

20.

Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148CrossRefPubMed

21.

Jones CJ, Rikli RE, Beam WC (1999) A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 70(2):113–119. https://doi.org/10.1080/02701367.1999.10608028 CrossRefPubMed

22.

Wolf SL, Catlin PA, Gage K, Gurucharri K, Robertson R, Stephen K (1999) Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile. Phys Ther 79(12):1122–1133PubMed

23.

Bohannon RW, Andrews AW, Thomas MW (1996) Walking speed: reference values and correlates for older adults. J Orthop Sports Phys Ther 24(2):86–90. https://doi.org/10.2519/jospt.1996.24.2.86 CrossRefPubMed

24.

Peolsson A, Hedlund R, Oberg B (2001) Intra- and inter-tester reliability and reference values for hand strength. J Rehabil Med 33(1):36–41CrossRefPubMed

25.

Sundh D, Nilsson AG, Nilsson M, Johansson L, Mellstrom D, Lorentzon M (2017) Increased cortical porosity in women with hip fracture. J Intern Med 281(5):496–506. https://doi.org/10.1111/joim.12587 CrossRefPubMed

26.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233CrossRefPubMed

27.

Washburn RA, Smith KW, Jette AM, Janney CA (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46(2):153–162CrossRefPubMed

28.

Angbratt M, Moller M (1999) Questionnaire about calcium intake: can we trust the answers? Osteoporos Int 9(3):220–225. https://doi.org/10.1007/s001980050140 CrossRefPubMed

29.

Blake GM, Rea JA, Fogelman I (1997) Vertebral morphometry studies using dual-energy x-ray absorptiometry. Semin Nucl Med 27(3):276–290CrossRefPubMed

30.

Genant HK, CY W, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148. https://doi.org/10.1002/jbmr.5650080915 CrossRefPubMed

31.

Griffith JF (2015) Identifying osteoporotic vertebral fracture. Quant Imaging Med Surg 5(4):592–602. https://doi.org/10.3978/j.issn.2223-4292.2015.08.01 PubMedPubMedCentral

32.

Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9(6):508–515. https://doi.org/10.1007/s001980050178 CrossRefPubMed

33.

Morris R, Harwood RH, Baker R, Sahota O, Armstrong S, Masud T (2007) A comparison of different balance tests in the prediction of falls in older women with vertebral fractures: a cohort study. Age Ageing 36(1):78–83. https://doi.org/10.1093/ageing/afl147 CrossRefPubMed

34.

Kwok AW, Gong JS, Wang YX, Leung JC, Kwok T, Griffith JF, Leung PC (2013) Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int 24(3):877–885. https://doi.org/10.1007/s00198-012-2040-8 CrossRefPubMed

35.

Sanfelix-Genoves J, Hurtado I, Sanfelix-Gimeno G, Reig-Molla B, Peiro S (2011) Impact of osteoporosis and vertebral fractures on quality-of-life. A population-based study in Valencia, Spain (The FRAVO Study). Health Qual Life Outcomes 9:20. https://doi.org/10.1186/1477-7525-9-20 CrossRefPubMedPubMedCentral

36.

Abdel-Hamid Osman A, Bassiouni H, Koutri R, Nijs J, Geusens P, Dequeker J (1994) Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis—a cross-sectional and longitudinal study. Bone 15(4):437–442CrossRefPubMed

37.

Broy SB (2016) The Vertebral Fracture Cascade: etiology and clinical implications. J Clin Densitom 19(1):29–34. https://doi.org/10.1016/j.jocd.2015.08.007 CrossRefPubMed

38.

Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18(12):1617–1624. https://doi.org/10.1007/s00198-007-0413-1 CrossRefPubMed

39.

Fink HA, Litwack-Harrison S, Ensrud KE, Shen J, Schousboe JT, Cawthon PM, Cauley JA, Lane NE, Taylor BC, Barrett-Connor E, Kado DM, Cummings SR, Marshall LM, Osteoporotic Fractures in Men Study G (2017) Association of Incident, clinically undiagnosed radiographic vertebral fractures with follow-up back pain symptoms in older men: the osteoporotic fractures in men (MrOS) study. J bone miner res. https://doi.org/10.1002/jbmr.3215

40.

Diaz-Arribas MJ, Fernandez-Serrano M, Royuela A, Kovacs FM, Gallego-Izquierdo T, Ramos-Sanchez M, Llorca-Palomera R, Pardo-Hervas P, Martin-Pariente OS (2017) Minimal clinically important difference in quality of life for patients with low back pain. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002298

Title: Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women
Authors: Lisa Johansson
Daniel Sundh
Martin Nilsson
Dan Mellström
Mattias Lorentzon
Publication date: 01-01-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-017-4296-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women

Abstract

Summary

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

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