Decreased physical health-related quality of life—a persisting state for older women with clinical vertebral fracture

Johansson, Lisa; Svensson, Hilda; Karlsson, Jan‐Erik; Olsson, Lars-Eric; Mellström, Dan; Lorentzon, Mattias; Sundh, Daniel

doi:10.1007/s00198-019-05044-0

Cited by 14 publications

(10 citation statements)

References 38 publications

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“…Although the majority of vertebral fractures are subclinical, they can cause pain, disability, deformity, and premature death [ 37 ]. Pain and postural changes associated with multiple vertebral compression fractures (kyphosis) can limit mobility and independent function, resulting in significantly diminished quality of life [ 38 ]. Multiple thoracic fractures can cause restrictive lung disease.…”

Section: Osteoporosis: Impact and Overviewmentioning

confidence: 99%

The clinician’s guide to prevention and treatment of osteoporosis

et al. 2022

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Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2-to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF)formerly the National Osteoporosis Foundationfirst published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores * M. S. LeBoff

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Section: Osteoporosis: Impact and Overviewmentioning

confidence: 99%

The clinician’s guide to prevention and treatment of osteoporosis

et al. 2022

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“…The effect of exercise on mobility as measured by the 2.45-m up and go is promising, but the magnitude of the effect was small (between-group difference of 0.38 s) and likely not clinically meaningful [ 46 ]. Maintaining physical activity and physical function is important for people with osteoporosis [ 47 ] and may prevent a cycle of physical impairment after vertebral fracture [ 1 , 8 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial

Stanghelle

Bentzen

Giangregorio

et al. 2020

BMC Musculoskelet Disord

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Background Exercise is recommended for individuals with vertebral fractures, but few studies have investigated the effect of exercise on outcomes of importance for this population. Post-intervention effects of exercise are even less studied. The objective of this study was to evaluate habitual walking speed and other health-related outcomes after cessation of a 3-month exercise intervention. Methods This follow-up study was conducted 3 months post-intervention of a randomised controlled trial. A total of 149 community-dwelling Norwegian women aged 65 years or older, diagnosed with osteoporosis and vertebral fracture were randomised into either exercise or control group. Primary outcome was habitual walking speed at 3 months. Secondary outcomes were other measures of physical fitness – including the Four Square Step Test (FSST), functional reach, grip strength and Senior Fitness Test – measures of health-related quality of life and fear of falling. Herein we report secondary data analysis of all outcomes at 6 months (3 months post-intervention). Data were analysed according to the intention-to-treat principle, linear mixed regression models were employed. Results For the primary outcome, habitual walking speed, there was no statistically significant difference between groups (0.03 m/s, 95%CI − 0.02 to 0.08, p = 0.271) at the 3-month post-intervention follow-up. For secondary outcomes of physical fitness, statistically significant differences in favour of the intervention group were found for balance using the FSST (− 0.68 s, 95%CI − 1.24 to − 0.11, p = 0.019), arm curl (1.3, 95%CI 0.25 to 2.29, p = 0.015), leg strength using the 30-s sit to stand (1.56, 95%CI 0.68 to 2.44, p = 0.001) and mobility using the 2.45-m up and go (− 0.38 s, 95%CI − 0.74 to − 0.02, p = 0.039). There was a statistically significant difference between the groups regarding fear of falling in favour of the intervention group (− 1.7, 95%CI − 2.97 to − 0.38, p = 0.011). No differences between groups were observed for health-related quality of life. Conclusion The results show the improved effects of a multicomponent exercise programme on outcomes like muscle strength, balance and mobility as well as fear of falling in a group of older women with osteoporosis and vertebral fracture 3 months post-intervention. Trial registration ClinicalTrials.gov Identifier: NCT02781974 . Registered 25.05.16. Retrospectively registered.

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“…Studies investigating time since onset of vertebral fracture, and its effect on HRQoL, have shown that a residual effect lasts for up to 7 years postfracture [ 47 , 48 ]. Furthermore, Johansson et al [ 49 ] have shown, in a recent population-based cross-sectional study of 3028 Swedish women aged 78.8 years, that a (self-reported) clinical vertebral fracture was associated with lower physical HRQoL (12-Item Short-Form Health Survey (SF-12)). Moreover, the association remained for up to 18.9 years independently of covariates such as age, weight, height, smoking, prior stroke, mental HRQoL, grip strength, and lumbar spine BMD [ 49 ].…”

Section: Clinical Significance Of Vertebral Fracturesmentioning

confidence: 99%

“…Furthermore, Johansson et al [ 49 ] have shown, in a recent population-based cross-sectional study of 3028 Swedish women aged 78.8 years, that a (self-reported) clinical vertebral fracture was associated with lower physical HRQoL (12-Item Short-Form Health Survey (SF-12)). Moreover, the association remained for up to 18.9 years independently of covariates such as age, weight, height, smoking, prior stroke, mental HRQoL, grip strength, and lumbar spine BMD [ 49 ]. However, other studies have reported the contrary with improvement of the HRQoL within 2 to 4 years after onset of vertebral fracture [ 50 , 51 ].…”

Section: Clinical Significance Of Vertebral Fracturesmentioning

confidence: 99%

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

et al. 2021

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Summary Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. Summary points • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment...

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Decreased physical health-related quality of life—a persisting state for older women with clinical vertebral fracture

Cited by 14 publications

References 38 publications

The clinician’s guide to prevention and treatment of osteoporosis

The clinician’s guide to prevention and treatment of osteoporosis

Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

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