1
|
Lee JH, Lee H, Gong HS. Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture. J Bone Metab 2023; 30:339-346. [PMID: 38073267 PMCID: PMC10721377 DOI: 10.11005/jbm.2023.30.4.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures. METHODS We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA. RESULTS The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; p<0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; p=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD. CONCLUSIONS Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.
Collapse
Affiliation(s)
- Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seoul,
Korea
| | - Hansang Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul,
Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam,
Korea
| |
Collapse
|
2
|
Asahi R, Nakamura Y, Koike Y, Kanai M, Watanabe K, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Does locomotive syndrome severity predict future fragility fractures in community-dwelling women with osteoporosis? Mod Rheumatol 2023; 33:1036-1043. [PMID: 36029035 DOI: 10.1093/mr/roac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We investigated whether the locomotive syndrome (LS) severity affects future fragility fractures in osteoporosis patients. METHODS In this retrospective cohort study, 315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed, of whom 244 were included in the analysis. At baseline, we obtained medical information, bone mineral density of the lumbar spine and femoral neck, and sagittal vertical axis. Additionally, LS risk was assessed using the two-step test, stand-up test, and 25-question geriatric locomotive function scale scores. The LS risk test results were used to classify LS severity, which was rated on a 4-point scale from stage 0 (robust) to 3 (worsening). Cox proportional hazards regression analysis was used to determine the association of the severity with future fragility fracture. RESULTS Fragility fractures occurred in 37 of 315 participants (11.8%). This study showed that sagittal vertical axis (hazard ratio = 1.014; 95% confidence interval, 1.005-1.023; p value = 0.003) and LS severity (hazard ratio =1.748; 95% confidence interval, 1.133-2.699; p = 0.012) were independent risk factors for incidence of fragility fracture. CONCLUSIONS This study revealed the LS severity to predicted fragility fractures. We suggested that the progression of LS associated with osteoporosis increases the fracture risk.
Collapse
Affiliation(s)
- Ryoma Asahi
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Yutaka Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Yoshinao Koike
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Masayoshi Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Kento Watanabe
- Department of Rehabilitation, Kawaguchi Sakura Hospital, Saitama, Japan
| | - Satoshi Yuguchi
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Tomohiko Kamo
- Department of Rehabilitation, Gunma Paz University, Gunma, Japan
| | - Masato Azami
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Satoshi Asano
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| |
Collapse
|
3
|
Asahi R, Nakamura Y, Kanai M, Watanabe K, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Association with sagittal alignment and osteoporosis-related fractures in outpatient women with osteoporosis. Osteoporos Int 2022; 33:1275-1284. [PMID: 35091788 DOI: 10.1007/s00198-021-06282-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED The baseline sagittal vertical axis (SVA) and pelvic tilt (PT) are independent risk factors of osteoporosis-related fractures in women with osteoporosis. We clarified the SVA and PT to predict the incidence of osteoporosis-related fractures. PURPOSE Sagittal alignment with osteoporosis women deteriorates with advancing age and sagittal alignment may indicate osteoporosis-related fractures in the future. However, whether the sagittal alignment predicts future osteoporosis-related fracture in patients with osteoporosis has not been clarified. We aimed to investigate the association between sagittal alignment and future osteoporosis-related fractures. METHODS This was a retrospective cohort study. Of the 313 participants (mean follow-up period, 2.9 years), 236 were included in the analysis. At baseline, we measured bone mineral density (BMD) of the lumbar spine and the femoral neck, sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis, sacral slope, pelvic tilt (PT), geriatric locomotive function scale (GLFS), two-step value, and stand-up test. The information on medications and the duration of treatment were reviewed from the medical records. Additionally, participants reported their history of falls at baseline. Multiple logistic regression analysis was used to determine the association of future osteoporosis-related fracture, and adjusted Odds ratios (OR) and 95% confidence interval (CI) were calculated with all predictors as covariates. All continuous variables were calculated using standardized OR (sOR). RESULTS Osteoporosis-related fractures occurred in 33 of 313 participants (10.5%). Multiple logistic regression analysis showed that a history of falls (OR =4.092, 95% CI: 1.029-16.265, p =0.045), SVA (sOR =4.228, 95% CI: 2.118-8.439, p <0.001), and PT (sOR =2.497, 95% CI: 1.087-5.733, p =0.031) were independent risk factors for future osteoporosis-related fractures. CONCLUSIONS This study revealed the SVA and PT to predict osteoporosis-related fractures. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION UMIN000036516 (April 1, 2019).
Collapse
Affiliation(s)
- R Asahi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan.
| | - Y Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - M Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - K Watanabe
- Department of Rehabilitation, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - S Yuguchi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - T Kamo
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - M Azami
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - H Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-machi, Nagano City, Nagano, 381-2227, Japan
| | - S Asano
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| |
Collapse
|
4
|
Asahi R, Nakamura Y, Kanai M, Watanabe K, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Stand-up test predicts occurrence of non-traumatic vertebral fracture in outpatient women with osteoporosis. J Bone Miner Metab 2021; 39:883-892. [PMID: 33988756 DOI: 10.1007/s00774-021-01229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/08/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The purpose of this retrospective study was to clarify the incidence of non-traumatic vertebral fracture among outpatient women with osteoporosis and to determine whether the stand-up test predicted the occurrence of non-traumatic vertebral fracture. MATERIALS AND METHODS A total of 242 postmenopausal women over 60 years of age who received outpatient osteoporosis treatment at our hospital between November 2013 and July 2020 were longitudinally evaluated in this study. We obtained medical information and radiographic parameters, including sagittal vertical axis, thoracic kyphosis, pelvic incidence, lumbar lordosis, pelvic tilt, and sacral slope at baseline. Additionally, we measured physical parameters, including height, weight, body mass index, lumbar bone mineral density, visual analog scale score for pain, and the stand-up test. RESULTS Vertebral fractures occurred in 20 of 242 participants (8.3%), and accounted for 48.8% the 41 total fractures in the study group. Among vertebral fractures, eight (40.0%) were traumatic, resulting from falls, and 12 (60.0%) were non-traumatic. Cox multivariate logistic regression analysis adjusted for age, body mass index, lumbar bone mineral density, and the time to non-traumatic vertebral fracture showed that the sagittal vertical axis (HR = 1.013, 95% CI 1.001-1.026), stand-up test score (HR = 3.977, 95% CI 1.156-13.683), and presence of difficulty with standing from a 20-cm-high seat using both legs (HR = 3.329, 95% CI 1.625-6.82) were independent risk factors for the occurrence of non-traumatic vertebral fracture. CONCLUSION The stand-up test may be useful as a simple screening tool for non-traumatic vertebral fracture in patients with osteoporosis.
Collapse
Affiliation(s)
- Ryoma Asahi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan.
| | - Yutaka Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Masayoshi Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Kento Watanabe
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - Satoshi Yuguchi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Tomohiko Kamo
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Masato Azami
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Hirofumi Ogihara
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - Satoshi Asano
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| |
Collapse
|