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De Rui M, Tarzia V, Mazzochin M, Bertocco A, Ceolin C, Trevisan C, Tessari C, Cavalli C, Piperata A, Coin A, Gerosa G, Sergi G. Surgical aortic valve replacement in elderly patients: effects on physical performance, cognitive function and health-related quality of life. Aging Clin Exp Res 2022; 34:643-652. [PMID: 34448150 PMCID: PMC8894170 DOI: 10.1007/s40520-021-01969-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022]
Abstract
Background Surgical aortic valve replacement (SAVR) is still the gold standard for treating aortic valve stenosis (AVS). Its effectiveness has been extensively examined in terms of perioperative mortality, but its impact on overall health has received much less attention. Aims To assess the physical performance, cognitive status, and health-related quality of life of elderly patients undergoing SAVR, in the short, medium and long term. Methods This single-center prospective study enrolled patients aged > 70 years who underwent isolated SAVR for severe AVS. Data were collected on each participant’s clinical status, physical performance, cognitive status, mood, and health-related quality of life. This multidimensional geriatric assessment was performed before surgery (T0), and again at 45 days (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-surgery. Baseline (T0) and follow-up (T2-T4) data were compared separately for patients grouped by gender using paired t-tests. Results Data from a total of 35 patients were analyzed. Compared with the baseline (T0), nutritional status worsened at T1, then gradually improved through to T4. Physical performance, mood, and health-related quality of life improved significantly after surgery. Cognitive function showed no change through to T3, but then deteriorated at T4. Conclusions Our results show that SAVR in patients over 70 years of age has a positive impact on nutrition, mood, and health-related quality of life. Cognitive function was not negatively affected in the short and medium term, although it deteriorated in the long term. SAVR also had a positive impact on the physical performance of our sample.
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Affiliation(s)
- Marina De Rui
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Mattia Mazzochin
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Anna Bertocco
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Chiara Ceolin
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Caterina Trevisan
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Chiara Tessari
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Chiara Cavalli
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Antonio Piperata
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Alessandra Coin
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, Cardiac Surgery Unit, University of Padova, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine-DIMED, Geriatrics Division, Clinica Geriatrica, University of Padova, via Giustiniani 2, 35128, Padova, Italy
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Trevisan C, Noale M, Mazzochin M, Greco GI, Imoscopi A, Maggi S, Spinella P, Manzato E, Welmer AK, Sergi G. Falls may trigger body weight decline in nursing home residents. Nutrition 2021; 90:111429. [PMID: 34481268 DOI: 10.1016/j.nut.2021.111429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The effect of falls on changes in body weight is still unknown. This study investigated the extent to which falls can modify the course of body weight in nursing home residents, and aimed to identify the factors that might modulate this effect. METHODS The sample included 132 residents aged ≥60 y who had experienced at least one fall after nursing home admission. Body weight was measured monthly in the 6 mo after the fall in the entire sample, and also in the 6 mo prefall in a subsample (n = 111). Sociodemographic and health data were obtained from medical records. Linear mixed models were used to estimate the average monthly changes in body weight after the fall in the total sample, and as a function of the sociodemographic and medical factors. RESULTS Falls modified the course of body weight in the total sample (β = -0.28, 95% confidence interval, -0.44 to -0.12, for the change in slope before and after fall) in all age classes and especially in individuals with severe cognitive impairment who received less-frequent informal visits (β = -0.55, 95% confidence interval, -0.87 to -0.22). Individuals aged ≥90 y and those with severe cognitive impairment had a steeper monthly weight decline in the 6 mo postfall, of 0.23 and 0.35 kg greater, respectively, than their younger and cognitively healthier counterparts. CONCLUSIONS Falls may trigger a body weight loss in nursing home residents, especially in the oldest old people and those with severe cognitive impairment who receive little support from informal caregivers. These findings highlight the importance of monitoring nutritional status of people who live in institutions after falls.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Mattia Mazzochin
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Giada Ida Greco
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Paolo Spinella
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Enzo Manzato
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy; National Research Council, Neuroscience Institute, Padua, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
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Sergi G, Dianin M, Bertocco A, Zanforlini BM, Curreri C, Mazzochin M, Simons LA, Manzato E, Trevisan C. Gender differences in the impact of metabolic syndrome components on mortality in older people: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2020; 30:1452-1464. [PMID: 32600955 DOI: 10.1016/j.numecd.2020.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The influence of metabolic syndrome (MetS) on mortality may be influenced by age- and gender-related changes affecting the impact of individual MetS components. We investigated gender differences in the association between MetS components and mortality in community-dwelling older adults. METHODS AND RESULTS Prospective studies were identified through a systematic literature review up to June 2019. Random-effect meta-analyses were run to estimate the pooled relative risk (RR) and 95% confidence intervals (95% CI) of all-cause and cardiovascular (CV) mortality associated with the presence of MetS components (abdominal obesity, high triglycerides, low HDL cholesterol, high fasting glycemia, and high blood pressure) in older men and women. Meta-analyses considering all-cause (103,859 individuals, 48,830 men, 55,029 women; 10 studies) and CV mortality (94,965 individuals, 44,699 men, 50,266 women; 8 studies) did not reveal any significant association for abdominal obesity and high triglycerides in either gender. Low HDL was associated with increased all-cause (RR = 1.16, 95% CI: 1.02-1.32) and CV mortality (RR = 1.34, 95% CI: 1.03-1.74) among women, while weaker results were found for men. High fasting glycemia was associated with higher all-cause mortality in older women (RR = 1.35, 95% CI: 1.22-1.50) more than in older men (RR = 1.21, 95% CI: 1.13-1.30), and CV mortality only in the former (RR = 1.36, 95% CI: 1.04-1.78). Elevated blood pressure was associated with increased all-cause mortality (RR = 1.16, 95% CI: 1.03-1.32) and showed marginal significant results for CV death only among women. CONCLUSIONS The impact of MetS components on mortality in older people present some gender differences, with low HDL cholesterol, hyperglycemia, and elevated blood pressure being more strongly associated to all-cause and CV mortality in women.
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Affiliation(s)
- Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Marta Dianin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Anna Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Bruno M Zanforlini
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Chiara Curreri
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Mattia Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Leon A Simons
- UNSW Sydney, St Vincent's Hospital, Sydney, Australia
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; Institute of Neuroscience, National Research Council, Padova, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
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Trevisan C, Alessi A, Girotti G, Zanforlini BM, Bertocco A, Mazzochin M, Zoccarato F, Piovesan F, Dianin M, Giannini S, Manzato E, Sergi G. The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women. J Clin Densitom 2020; 23:381-389. [PMID: 31350204 DOI: 10.1016/j.jocd.2019.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Smoking is recognized among the risk factors for osteoporosis, but only few studies have comprehensively explored its influence on bone metabolism and strength. We aimed to evaluate smoking effects on calcium-phosphate metabolism, bone mineral density (BMD) and fracture risk in postmenopausal women. METHODS Our sample included 1067 postmenopausal women who arrived to our osteoporosis outpatient clinic. Anamnestic data, smoking habits (categorized as never, former, and current; and by smoking intensity and duration), biochemical parameters, lumbar/femoral BMD, and presence of vertebral fractures were recorded. In a subsample of 357 women, the changes in BMD after a 2-yr follow-up period were also assessed. RESULTS Current smokers had shorter reproductive age, lower body mass index, and higher prevalence of heavy alcohol consumption than former/never smokers. They also had lower PTH values and weaker linear association between serum vitamin D and parathyroid hormone (current β = -0.11[SE = 0.004]; former β = -0.14[SE = 0.01]; never β = -0.20[SE = 0.003]; p < 0.01 for all). Baseline BMD did not reflect differences based on smoking habits, duration or intensity. However, after 2 years, only current smokers significantly worsened in femural BMD. After adjustment for confounders, the chance of having sustained vertebral fractures at the first evaluation increased by 74% (95% confidence interval:1.07-2.83) in current compared with never smokers, especially among heavy smokers. CONCLUSIONS Smoking may negatively affect bone by inhibiting vitamin D-parathyroid hormone axis, reducing estrogen exposure, promoting risky health behaviors, and accelerating bone loss, especially at the femur. No significant differences were observed in these outcomes among former smokers, suggesting that quitting smoking has beneficial effects on bone health.
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Affiliation(s)
- Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy.
| | - Agnese Alessi
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Gaia Girotti
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | | | - Anna Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Mattia Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Francesca Zoccarato
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Francesca Piovesan
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Marta Dianin
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
| | - Sandro Giannini
- Department of Medicine, ClinicaMedica 1, University of Padua and Regional Centre for Osteoporosis, Padua, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy; National Research Council, Neuroscience Institute, Padua, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padua, Padua, Italy
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Valmorbida E, Trevisan C, Imoscopi A, Mazzochin M, Manzato E, Sergi G. Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization. Clin Nutr 2020; 39:3687-3694. [PMID: 32291111 DOI: 10.1016/j.clnu.2020.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/18/2020] [Accepted: 03/27/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity. METHODS This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively. RESULTS During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80-6.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04-1.60). CONCLUSIONS Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization.
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Affiliation(s)
- Elena Valmorbida
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
| | | | - Mattia Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
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Zanforlini BM, Trevisan C, Bertocco A, Piovesan F, Dianin M, Mazzochin M, Alessi A, Zoccarato F, Manzato E, Sergi G. Phase angle and metabolic equivalents as predictors of frailty transitions in advanced age. Exp Gerontol 2019; 122:47-52. [DOI: 10.1016/j.exger.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 10/27/2022]
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Bano G, Pigozzo S, Piovesan F, Mazzochin M, Dianin M, Bedogni M, Zaninotto M, Giannini S, Perissinotto E, Manzato E, Plebani M, Sergi G. Influence of serum 25-hydroxyvitamin D levels, fat-free mass, and fat mass on bone density, geometry and strength, in healthy young and elderly adults. Exp Gerontol 2018; 113:193-198. [PMID: 30316812 DOI: 10.1016/j.exger.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The association between serum 25-hydroxyvitamin D (25-OHD) levels and cortical/trabecular bone parameters has been explored in the elderly, but less so in younger adults; body composition may also influence bone parameters across the life span. We aimed to investigate, with peripheral quantitative computerized tomography (pQCT), the relationship between serum 25-OHD levels and bone geometry and strength and, at the same time, to explore the influence of fat mass and fat-free mass on bone parameters, for the tibia and radius, in healthy young and elderly adults. METHODS The study involved 149 healthy adults grouped by age: 65 were under 65 years old, and 84 were older. All participants were assessed in terms of: clinical history; serum 25-OHD levels; fat-free mass (FFM) and fat mass (FM), measured with DXA; total and cortical bone cross-sectional area (CSA, CSAc), and trabecular and cortical bone mineral density (BMDt, BMDc); and fracture load x and y for the tibia and radius, measured with pQCT. RESULTS In the younger group, the association between 25-OHD levels and bone parameters did not remain as significant for any parameters after multivariate adjustment. In the elderly, 25-OHD correlated with CSAc (partial R2 = 0.33), fracture load x (partial R2 = 0.54), and fracture load y (partial R2 = 0.46) for the radius, and marginally with BMDt (partial R2 = 0.09; B-H adjusted p < 0.05 for all) for the tibia. FFM correlated with all bone parameters in both age groups. In the elderly group alone, FM correlated with BMDt at the tibia (r = 0.25, p < 0.05), with CSA at both sites (radius r = -0.25, p < 0.05; tibia r = -0.32, p < 0.001), and with fracture load y on the radius (r = -0.22, p < 0.05). CONCLUSION While serum 25-OHD levels correlated only weakly with bone parameters in younger adults, a significant relationship was observed for elderly people. Fat-free mass showed positive simple correlation with pQCT-derived bone parameters in both age groups except with BMDc in the younger group. Further longitudinal studies are needed to clarify these relationships.
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Affiliation(s)
- Giulia Bano
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy.
| | - Sabrina Pigozzo
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Francesca Piovesan
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Mattia Mazzochin
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Marta Dianin
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Marco Bedogni
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Sandro Giannini
- Department of Medicine, Clinica Medica Ia, Padova University Hospital, Padova, Italy
| | - Egle Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Enzo Manzato
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, Padova University Hospital, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Division, Padova University Hospital, Padova, Italy
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Pizzato S, Trevisan C, Lucato P, Girotti G, Mazzochin M, Zanforlini BM, Bano G, Piovesan F, Bertocco A, Zoccarato F, Dianin M, Manzato E, Sergi G. Identification of asymptomatic frailty vertebral fractures in post-menopausal women. Bone 2018; 113:89-94. [PMID: 29753150 DOI: 10.1016/j.bone.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/07/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE Vertebral fractures are associated with persistent pain, disability and mortality. However, around two thirds of women with vertebral fractures are unaware of them. We aimed to analyze which factors could mostly be associated to the presence of vertebral fractures in post-menopausal women, and evaluate the effectiveness of current screening criteria for the detection of vertebral fractures in an outpatient setting. METHODS We evaluated 1132 post-menopausal women referred to the osteoporosis outpatient clinic of the Geriatrics Department of Padova. For each participant we assessed: anthropometric data, femoral and lumbar bone mineral density (BMD), dorso-lumbar X-rays, bone metabolism markers. Current recommendations for X-ray examinations by SIOMMMS (Società Italiana di Osteoporosi, Metabolismo Minerale e Malattie dello Scheletro) and ISCD (International Society of Clinical Densitometry) versus routine X-ray examinations were considered, and fracture risk was assessed through the derived FRAX (DeFRA) tool. RESULTS Of the women included in our study, 28% presented vertebral fractures, most of these previously unknown (82.8%). Lumbar BMD did not differ between patients with and without vertebral fractures. According to SIOMMMS guidelines, 50% of patients <60 years with unknown vertebral fractures would have been excluded from spinal X-ray examination. According to ISCD recommendations, the number of patients excluded reached 94.6% in the <60 age-group and 84.9% in the 60-70 age-group. The under-identification of vertebral fractures led to the 10-year risk of fractures computed by DeFRA being underestimated by around 15%. CONCLUSIONS BMD, particularly in the lumbar site, may not properly predict the presence of vertebral fractures in post-menopausal women. Improvement of the current recommendations for spinal X-ray examination may lead to early identification and better management of patients with vertebral fractures.
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Affiliation(s)
- S Pizzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy.
| | - P Lucato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - G Girotti
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - M Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - B M Zanforlini
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - G Bano
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - F Piovesan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - A Bertocco
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - F Zoccarato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - M Dianin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - E Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; National Research Council, Institute of Neuroscience, Aging Branch, Padova, Italy
| | - G Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
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