Situational risk factors for fall-related vertebral fractures in older men and women

Global, regional, and national burden of vertebral fractures due to falls from 1990 to 2021 and predictions for the next 15 years: A systematic analysis of the global burden of disease 2021 study

OBJECTIVES

This study utilized the latest data from the 2021 Global Burden of Disease Study to analyze the incidence, prevalence, and years lived with disability due to vertebral fractures from 1990 to 2021, providing information for effective management and prevention strategies.

METHODS

This study describes the trends in incidence, prevalence, and years lived with disability (YLDs) due to vertebral fractures caused by falls. It employs methods such as the Age-Period-Cohort (APC) model, joinpoint regression analysis, and decomposition analysis for further investigation, and calculates the ASIR, ASPR, and ASYR. Finally, it predicts the incidence trend for the next 15 years using the Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

In 2021, the number of new cases of vertebral fractures due to falls globally reached 4.7 million, with a total prevalence of 3.67 million cases, and years lived with disability (YLDs) amounted to 370,000. Compared to 1990, the estimated annual percentage change (EAPC) was -0.37 (-0.41, -0.32), -0.35 (-0.39, -0.31), and -0.37 (-0.41, -0.33) respectively, indicating a declining trend. There are significant differences in the disease burden among different countries and regions. The APC model, Joinpoint model, and ARIMA forecasting model indicate a global declining trend in the disease burden of vertebral fractures.

CONCLUSIONS

Although the burden of vertebral fractures is on a downward trend, it continues to increase in low and middle SDI regions, as well as among the elderly population. Therefore, targeted preventive measures are still necessary to address the health outcomes related to vertebral fractures.

Oral Frailty as a Risk Factor for Fall Incidents among Community-Dwelling People

BACKGROUND

Identifying older adults with a high risk of falling and providing them with appropriate intervention are vital measures for preventing fall incidents. Scholars report that oral frailty, a decline in oral function, is related to physical function; thus, it bears a potential association with fall risks. This study aimed to investigate the relationship between fall incidents and the status of physical and oral frailty among a sample of residents in Osaka Prefecture.

SUBJECTS AND METHODS

This study targeted community-dwelling people aged 50 years and older who responded to an annual questionnaire survey using a health app for 2 consecutive years, namely, 2020 and 2021. This study analyzed responses from 7591 (62 ± 7 years) participants and determined the status of their oral frailty and comprehensive and physical frailty using the Kihon Checklist.

RESULTS

In the 2020 and 2021 surveys, 17% and 19% of the participants exhibited oral frailty and experienced a fall in the previous year, respectively. Logistic regression analysis demonstrated that oral frailty (adjusted odds ratio: 1.553) and physical frailty as well as low levels of awareness of frailty were significant explanatory variables of the occurrence of fall incidents during the subsequent year.

CONCLUSIONS

Future studies are required to elucidate the mechanisms by which oral frailty induces fall incidents.

Effects of resistance and balance exercises for athletic ability and quality of life in people with osteoporotic vertebral fracture: Systematic review and meta-analysis of randomized control trials

Purpose

This study aimed to use meta-analysis to determine the impact of resistance and balance training on athletic ability and quality of life for patients with osteoporotic vertebral fracture (OVF).

Methods

This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria for systematic reviews and meta-analyzes. The PubMed, Web of science, Cochrane, Embase, and CNKI databases were searched for randomized controlled trials (RCTs) up to September 2022. The search strategy was related to the intervention measures, population, and results, and was structured around the search terms: "Exercise," "Osteoporotic vertebral fracture," and "activities of function." Two reviewers strictly implemented the inclusion and exclusion criteria. Subgroup analyzes of age and training duration were performed for the main outcomes.

Results

We included 12 RCTs (n = 1,289) of resistance and balance training in patients with OVF. Compared with controls, the intervention group showed improvements on the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis, visual analog pain scale, Timed Up and Go, falls efficacy scale international (FES-I), kyphosis, and functional reach. On subgroup analysis, the effect was more significant when training continued >10 weeks.

Conclusion

Resistance and balance exercise training improved function and balance, and reduced fall risk in patients with OVF. We recommend resistance and balance training for at least 10 weeks. Future multicenter, large sample trials are needed for more reliable conclusions.

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Background

Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field.

Purpose

This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline.

Methods

The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations.

Results

Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively.

Conclusions

The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.

Dynamic Spine Hyperflexion Is Related to Vertebral Compression Fractures in Postmenopausal Women

OBJECTIVE

Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of spine; however, the fractures are usually associated with the flexion posture of spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.

METHODS

In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women (67.45 ± 6.68 years) with vertebral compression fractures (study group) and 310 postmenopausal women (66.57 ± 8.22 years) without vertebral compression fractures (control group) from June 2017 to July 2019. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, and Mann Whitney U were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb. The cut-off of the TLHCobb was determined by ROC curve and Youden's index.

RESULTS

Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15-3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and >20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82-4.27) and 4.83 (3.24-7.20), respectively. TLHCobb, disk height (semiquantitative grading score) and QCT values differed between the study and control groups (p < 0.001 for all three). There were no significant differences in body mass index (BMI), or coronal TLCobb between the two groups.

CONCLUSION

There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.

The risk of falls among the aging population: A systematic review and meta-analysis

Aim

This study aims to clarify the risk factors for falls to prevent severe consequences in older adults.

Methods

We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared.

Results

We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls.

Conclusion

Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.

The Role of Fall Biomechanics in the Cause and Prevention of Bone Fractures in Older Adults

PURPOSE OF REVIEW

Adults over age 65 experience the highest rates of bone fracture, and 90% of fractures in older adults are caused by falls from standing height or lower. Advances in fracture prevention rely on our ability to prevent falls, reduce the severity of falls, and enhance the resistance of bone to trauma. To help guide these efforts, we need improved understanding on the types of falls that cause fractures.

RECENT FINDINGS

In this review, we describe recent evidence on how the mechanics of falls in older adults influence the risk for fractures to the hip, wrist, vertebrae, and humerus. We discuss how fracture risk depends on fall height, fall direction, and landing configuration. We also review the benefits of exercise, wearable protective gear, and environmental modifications in preventing fractures in older adults. Our findings highlight promising new directions in fracture prevention, and the need for collaboration between the bone and falls research communities to implement proven strategies and generate new solutions.