A multi-dimensional questionnaire quantifying quality of life in elderly osteoporotic women: the Italian triple-Q osteoporosis study

The Relationship Between Storey of Buildings and Fall Risk

Purpose: This study examined the association between storey of building and fall risk in older adults' residences and residents' level of fear of falling. Methods: The National Health and Ageing Trends Study (NHATS) collected information that would provide an understanding of basic trends people aged 65 years and older. Using a longitudinal survey, the present study employed the first round of NHATS data that was collected in 2011. In the first round, 12,411 participants were enrolled, and 8,077 interviews were completed. The study sample sizes for falling and worry about falling are 6,153 and 6,142, respectively. Results: Unadjusted analysis revealed that storey of building was a risk factor for fall and worry about falling. There was a higher prevalence for fall and worry about falling when subjects lived in single storey of building compared with the subjects live in multi-storey. Logistic regression analysis showed no highly significant between storey of building and the fall/fear of falling. Conclusion: Several clinical factors independently were indicated pertaining to the fall and worry about falling in older adult's residences.

High prevalence of undiagnosed vertebral fractures in patients suffering from hip fracture at their hospital admission: weak concordance among observers

BACKGROUND

Vertebral fracture is often underdiagnosed. Patients with hip fracture may suffer from vertebral fracture without knowing it. The diagnosis of vertebral fracture is sometimes difficult because there is no consensus regarding the definition of osteoporotic vertebral fracture, and several indexes may be used to diagnose it and the concordance between several observers may not be optimal.

OBJECTIVE

To study the concordance in the diagnosis of vertebral fracture done by three different doctors: an orthopedic surgeon, a radiologist, and a bone mineral metabolism expert.

METHODS

A lateral thoracic-lumbar spine X-Ray was performed in 177 patients suffering from hip fracture to assess the presence or absence of vertebral fractures. Three different observers applied Genant's criteria for it. Concordance between observers was measured using Cohen's kappa coefficient.

RESULTS

Patients suffering from hip fractures have undiagnosed vertebral fractures in a range that varies from 41.8 to 47.5% depending on the observer. The concordance in the diagnosis of vertebral fractures is quite low, ranging a Cohen's kappa coefficient from 0.43 to 0.55 and a percentage of concordance varying from 64 to 72%. The best concordance was found between observers 1 and 3.

DISCUSSION

Depending on the observer who made the diagnosis, the prevalence of previously undiagnosed vertebral fractures in patients with HF varied widely. We selected three different observers to assess the possible differences in the diagnosis of vertebral fractures among these patients and using the same method (Genant's semi-quantitative assessment), surprisingly, there was little concordance among the three of them.

CONCLUSION

Patients with hip fracture have high prevalence of undiagnosed vertebral fractures. The diagnosis of these fractures varies widely depending on the observers and the Cohen's kappa coefficient and percentage of concordance is rather low.

Health-related quality of life in women referred for bone density assessment: relationships with bone mineral density, fracture and co-morbidity

PURPOSE

To identify variables that might influence health-related quality of life (HRQoL) in patients with and without a history of fracture, attending bone mineral density (BMD) assessment prior to diagnosis of osteoporosis.

METHODS

This cross-sectional study included 312 newly referred postmenopausal women attending for a DXA scan, without a diagnosis of osteoporosis. Data were obtained from the medical history and the General Practitioner's letter. HRQoL, using SF36 was scored using published algorithms with reference to an age-related population from England. Regression analyses were used to determine relationships between HRQoL and BMD, age, fracture status and co-morbidities.

RESULTS

For all patients, the age-related physical component summary (PCS) and mental component summary (MCS) scores were 46 ± 10 and 47 ± 10, respectively. Controlling for confounding variables, low BMD at the femoral neck was associated with worse PCS scores (p = 0.010) and MCS scores (p = 0.034) in patients without fracture. In patients with a history of fracture, this relationship was less evident, and younger age (p < 0.00), increasing BMI (p = 0.016) and number of co-morbidities (p = 0.042) were associated with reductions in PCS scores.

CONCLUSIONS

Patients referred for BMD assessment before a diagnosis of osteoporosis had reduced PCS scores. In patients without fracture, low BMD contributed to this reduction in health-related quality of life. Low PCS scores in patients with fracture were seen only in younger subjects with osteoporosis.

The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults

PURPOSE

The purpose of this study was to test a model delineating the factors known to influence fear of falling and exercise behavior among older adults.

DESIGN AND METHODS

This was a secondary data analysis using baseline data from the Bone Health study. A total of 866 individuals from two online communities participated in the study: 161 (18.6%) were from SeniorNet and 683 (78.9%) were from MyHealtheVet. More than half (63%) of the participants were male with a mean age of 62.8 (SD = 8.5) years. The majority was White (89%) and married (53%) and had some college education (87%).

RESULTS

Knowledge about osteoporosis and awareness one has a diagnosis of osteoporosis directly influenced fear of falling, and knowledge of osteoporosis directly and indirectly influenced exercise behavior. A diagnosis of osteoporosis indirectly influenced exercise behavior. Taken together, the hypothesized model explained 13% of the variance in exercise behavior.

IMPLICATIONS

Improving knowledge of osteoporosis and awareness of having a diagnosis of osteoporosis, decreasing fear of falling, and strengthening self-efficacy and outcome expectations for exercise may help improve exercise behavior among older adults.

Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture: a systematic review

To review whether osteoporosis in the absence of vertebral fracture (VFX) affects health-related quality of life (HRQoL), a systematic search of the main literature databases for HRQoL in patients with osteoporosis without VFX was undertaken. This was undertaken. This identified 1,327 articles as potentially relevant to the review. After screening of abstracts and reviewing 168 articles in detail, 27 were considered relevant. HRQoL data were extracted and collated into tables and, where possible, were converted into normative scores and further analysed. Data relating to the associations between HRQoL and bone mineral density (BMD) were also collated. Of the 27 articles included, only 5 directly compared osteoporosis without VFX with a control group (BMD T-score > -1.0, without VFX). Extracted raw data from 21 articles demonstrated that patients with osteoporosis without VFX had clinically relevant reductions in role physical, general health, vitality, mental health domains and the mental component summary score, using SF36. Using Qualeffo-41, pain and physical function were worse in these patients. Also, HRQoL was related to upper femur, but not lumbar spine BMD. HRQoL data in patients with osteoporosis without VFX are limited and variable but suggest that HRQoL is adversely affected by osteoporosis in the absence of VFX. The association of lower BMD and worse HRQoL suggests that more attention should be paid to HRQoL in those without VFX. Future studies are needed to investigate HRQoL in patients with osteoporosis in the absence of fracture, controlling for co-morbidities and social and economic status.