Restrictive pulmonary dysfunction is associated with vertebral fractures and bone loss in elderly postmenopausal women

Watanabe, Reiko; Shiraki, Masataka; Saito, Mitsuru; Okazaki, Ryo; Inoue, Daisuke

doi:10.1007/s00198-017-4337-0

Cited by 30 publications

(14 citation statements)

References 37 publications

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“…Whether this is true in adults who experience permanent vertebral deformity as children merits further study. In the aging, VF contribute to excess mortality (62), and among adult post-menopausal women without a history of pulmonary disease, those with VF had restrictive pulmonary dysfunction compared to those without VF (63). Together, these adult studies suggest that permanent reductions in vertebral height sustained in childhood may have important consequences later in life.…”

Section: Some Children Can Recover From Gio Through Reshaping Of Fracmentioning

confidence: 99%

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Ward

2020

Front. Endocrinol.

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Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population (“STOPP”) Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.

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Section: Some Children Can Recover From Gio Through Reshaping Of Fracmentioning

confidence: 99%

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Ward

2020

Front. Endocrinol.

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“…19,27 Thoracic deformity and pain linked to OVF may compromise respiratory function and balance, increasing the risk of death from respiratory disease or from sustaining an injury such as a hip fracture following a fall. 19,28,29 QoL and excess mortality progressively worsen as the number of OVFs increase.…”

Section: Recruitmentmentioning

confidence: 99%

“…64,70,99,101 In addition, hyperkyphosis and vertebral fracture are associated with compromised respiratory function and this may significantly limit maximal aerobic capacity. 29,81 People in this age group are also likely to have other comorbidities such as cardiovascular disease, which can limit exercise capacity. Considering this, moderate intensity exercise is most appropriate for this population and specific screening for comorbidities and use of the Borg Rating of Perceived Exertion (RPE) scale to guide exercise intensity is recommended.…”

Section: Safetymentioning

confidence: 99%

“…190 Our values are more comparable to DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk groups with pulmonary disease and probably reflect the association between vertebral fractures and impaired lung function. 29,191 For the 6MWT, a change of 20 m has been estimated to be a meaningful change in response to treatment. 188 In both the SPPB and 6MWT, significant increases were seen from baseline to 4 months in the exercise therapy arm compared with the SSPT arm.…”

Section: Short Physical Performance Battery and 6-minute Walk Testmentioning

confidence: 99%

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Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT

Barker

Newman

Stallard

et al. 2019

Health Technol Assess

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Background A total of 25,000 people in the UK have osteoporotic vertebral fracture (OVF). Evidence suggests that physiotherapy may have an important treatment role. Objective The objective was to investigate the clinical effectiveness and cost-effectiveness of two different physiotherapy programmes for people with OVF compared with a single physiotherapy session. Design This was a prospective, adaptive, multicentre, assessor-blinded randomised controlled trial (RCT) with nested qualitative and health economic studies. Setting This trial was based in 21 NHS physiotherapy departments. Participants The participants were people with symptomatic OVF. Interventions Seven sessions of either manual outpatient physiotherapy or exercise outpatient physiotherapy compared with the best practice of a 1-hour single session of physiotherapy (SSPT). Main outcome measures Outcomes were measured at 4 and 12 months. The primary outcomes were quality of life and muscle endurance, which were measured by the disease-specific QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis – 41 items) and timed loaded standing (TLS) test, respectively. Secondary outcomes were (1) thoracic kyphosis angle, (2) balance, evaluated via the functional reach test (FRT), and (3) physical function, assessed via the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), Physical Activity Scale for the Elderly, a health resource use and falls diary, and the EuroQol-5 Dimensions, five-level version. Results A total of 615 participants were enrolled, with 216, 203 and 196 randomised by a computer-generated program to exercise therapy, manual therapy and a SSPT, respectively. Baseline data were available for 613 participants, 531 (86.6%) of whom were women; the mean age of these participants was 72.14 years (standard deviation 9.09 years). Primary outcome data were obtained for 69% of participants (429/615) at 12 months: 175 in the exercise therapy arm, 181 in the manual therapy arm and 173 in the SSPT arm. Interim analysis met the criteria for all arms to remain in the study. For the primary outcomes at 12 months, there were no significant benefits over SSPT of exercise [QUALEFFO-41, difference –0.23 points, 95% confidence interval (CI) –3.20 to 1.59 points; p = 1.000; and TLS test, difference 5.77 seconds, 95% CI –4.85 to 20.46 seconds; p = 0.437] or of manual therapy (QUALEFFO-41, difference 1.35 points, 95% CI –1.76 to 2.93 points; p = 0.744; TLS test, difference 9.69 seconds (95% CI 0.09 to 24.86 seconds; p = 0.335). At 4 months, there were significant gains for both manual therapy and exercise therapy over SSPT in the TLS test in participants aged < 70 years. Exercise therapy was superior to a SSPT at 4 months in the SPPB, FRT and 6MWT and manual therapy was superior to a SSPT at 4 months in the TLS test and FRT. Neither manual therapy nor exercise therapy was cost-effective relative to a SSPT using the threshold of £20,000 per quality-adjusted life-year. There were no treatment-related serious adverse events. Conclusions This is the largest RCT to date assessing physiotherapy in participants with OVFs. At 1 year, neither treatment intervention conferred more benefit than a single 1-hour physiotherapy advice session. The focus of future work should be on the intensity and duration of interventions to determine if changes to these would demonstrate more sustained effects. Trial registration Current Controlled Trials ISRCTN49117867. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 44. See the NIHR Journals Library website for further project information.

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“…In previous studies investigating the relationship between vertebral fractures and bone mineral density (BMD) in patients with COPD, BMD was not a good predictor of vertebral fracture. Watanabe et al [9] reported that 79.4% had prevalent vertebral fracture whereas only 38.8% had BMD-defined osteoporosis (T≤2.5) in 136 Japanese patients. This result suggested the involvement of BMDindependent mechanisms in COPD patients.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Restrictive Pulmonary Dysfunction on Osteoporotic Thoracic Vertebral Fractures

et al. 2021

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To examine the influence of restrictive pulmonary dysfunction on osteoporotic thoracic vertebral fractures. Overview of Literature: Osteoporotic thoracic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to pulmonary function impairment. Impaired pulmonary function could be associated with vertebral fractures. However, an association between osteoporotic thoracic vertebral fractures and pulmonary function remains controversial. Methods: A total of 96 patients were enrolled in this study, 30 of whom had osteoporotic thoracic vertebral fractures (group 1), 30 with chronic back pain (group 2), and 36 with chronic pulmonary diseases (group 3). Radiologic study of prevalent vertebral fractures, thoracic kyphotic angle, bone mineral density, relaxed expiratory vital capacity, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) in spirometry was investigated. Results: The mean FVC and FEV1 were 75.66%±20.23% and 79.93%±22.48%, respectively, in group 1; 84.50%±16.25% and 91.87%±21.65%, respectively, in group 2; and 91.64%±17.53% and 91.03%±23.71%, respectively, in group 3. Group 1 (patients with osteoporotic thoracic vertebral fracture) had the lowest FVC among the three groups (p=0.01). Group 1 revealed worse result of pulmonary dysfunction than group 3 (patients with chronic pulmonary diseases) (p=0.01). The average kyphosis angle of the thoracic spine was 26.95°±15.17°, 36.47°±20.08°, and 28.58°±10.58° in groups 1, 2, and 3, respectively. There was a negative correlation between thoracic kyphosis and FEV1 (r=−0.309, p=0.01). Conclusions: The results suggest that osteoporotic thoracic vertebral fracture burden could be affected by restrictive pulmonary dysfunction.

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Restrictive pulmonary dysfunction is associated with vertebral fractures and bone loss in elderly postmenopausal women

Abstract: Diminished FVC was associated with prevalent vertebral fractures and decreased BMD in Japanese postmenopausal women without apparent pulmonary diseases. Mechanism of such association between pulmonary function and bone status remains to be determined.

Cited by 30 publications

References 37 publications

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT

The Influence of Restrictive Pulmonary Dysfunction on Osteoporotic Thoracic Vertebral Fractures

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