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Patel R, Shen J, Nichols JF, Schousboe JT, Woods GN, Katzman WB, Kado DM. Trabecular bone score and its association with Cobb angle kyphosis in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2022; 33:1171-1176. [PMID: 35031808 PMCID: PMC9010364 DOI: 10.1007/s00198-021-06267-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED Hyperkyphosis (HK), or accentuated forward spinal curvature, commonly affects older people, although its causes are not completely understood. We tested whether a measure of bone quality, trabecular bone score (TBS), is associated with HK in 1997 older men, and determined that men with degraded TBS were more likely to have HK. INTRODUCTION While vertebral fractures and low bone mineral density (BMD) contribute to kyphosis progression, it is unknown whether the trabecular bone score (TBS) may provide additional information on bone quality that could influence the degree of kyphosis. We hypothesized that degraded TBS would be associated with hyperkyphosis (HK) defined as a Cobb angle > 50°. METHODS Using data from 1997 participants of the Osteoporotic Fractures in Men (MrOS) Study who had baseline TBS and Cobb angle kyphosis measured, we investigated whether men with degraded TBS were more likely to be hyperkyphotic, even after adjustment for BMD and prevalent vertebral fractures. RESULTS Men were an average age of 74 ± 6 (mean ± SD) years with a mean kyphosis angle of 38.6 ± 11.5°, 295 (15%) were classified as hyperkyphotic, and 416 (21%) had degraded TBS. Compared with men with TBS > 1.2, men with degraded TBS were more likely to have HK (OR: 1.47, 95% CI: 1.06-2.06, p = 0.02) after adjusting for age, clinic, race, BMI, hip BMD, and prevalent vertebral fracture. If spine instead of hip BMD was included in the model, the odds ratio decreased to 1.35 (95% CI: 0.97-1.89, p = 0.08). CONCLUSIONS Older men with degraded TBS are more likely to have HK not explained by underlying vertebral fractures.
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Affiliation(s)
- R Patel
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - J Shen
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - J F Nichols
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - J T Schousboe
- Park Nicollet Clinic and Health Partners Institute and University of Minnesota, Minneapolis, MN, USA
| | - G N Woods
- Department of Medicine, University of California San Diego and VA San Diego Health Care System, La Jolla, CA, USA
| | - W B Katzman
- University of California, San Francisco, San Francisco, CA, USA
| | - D M Kado
- Department of Medicine, Stanford University, Stanford, California and VA Palo Alto, Palo Alto, CA, USA.
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McDaniels-Davidson C, Nichols JF, Vaida F, Marshall LM, Kado DM. Kyphosis and 3-year fall risk in community-dwelling older men. Osteoporos Int 2020; 31:1097-1104. [PMID: 32040599 PMCID: PMC7444683 DOI: 10.1007/s00198-019-05155-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Abstract
Hyperkyhosis is thought to be a fall risk factor in older adults. This large study of older men found that fall risk increased with greater kyphosis measured with the blocks method, but did not find an association between kyphosis and falls when measured by the commonly used the Cobb angle method. INTRODUCTION Research suggests an association between hyperkyphosis and falls in community-dwelling older adults, though this has not been investigated within large, population-based studies. This study sought to determine whether two measures of kyphosis prospectively predict fall risk over 3 years among older men. METHODS Within the Osteoporotic Fractures in Men Study (MrOS), we conducted two 3-year prospective studies of 2346 and 2928 men. The first group had kyphosis measured by the Cobb angle at visit 1, while the second group had kyphosis assessed with the blocks method at visit 3; both groups then self-reported falls tri-annually for 3 years. Poisson regression with GEE was used to obtain relative risks (RR) of falls. RESULTS The fall rates over 3 years were 651/1000 person-years among the visit 1 sample (mean age 74 ± 6 years) and 839/1000 person-years among the visit 3 sample (mean age 79 ± 5 years). In adjusted models of the visit 3 sample, the risk of falls was increased by 12% for each standard deviation increase (1.4 blocks) in the number of blocks required to achieve a neutral head and neck position (RR = 1.12, 95% CI = 1.06, 1.18). The Cobb angle was not associated with falls in the visit 1 sample. CONCLUSIONS Although the Cobb angle did not predict falls in community-dwelling older men over 3 years, the blocks method of measuring kyphosis was predictive of falls in this population. This difference could be due to the Cobb angle's focus on thoracic kyphosis, whereas the blocks method may additionally capture abnormal cervical spine curvature.
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Affiliation(s)
- C McDaniels-Davidson
- Joint Doctoral Program in Public Health (Epidemiology), San Diego State University/University of California, San Diego, San Diego, CA, USA.
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - F Vaida
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - L M Marshall
- Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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Bullen AL, Anderson CAM, Hooker ER, Kado DM, Orwoll E, Pasch A, Ix JH. Correlates of T 50 and relationships with bone mineral density in community-living older men: the osteoporotic fractures in men (MrOS) study. Osteoporos Int 2019; 30:1529-1531. [PMID: 30887076 PMCID: PMC6615942 DOI: 10.1007/s00198-019-04925-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE T50 is a novel serum-based marker that assesses the propensity of calcification in serum. Shorter T50 indicates greater propensity to calcify and it has been associated to cardiovascular disease (CVD) and mortality among patients with kidney disease. In the general population, neither the correlates of T50 nor the relationships of T50 with bone mineral density (BMD) are known. METHODS We performed a nested cross-sectional study selecting 150 individuals at random among participants from the Osteoporotic Fractures in Men (MrOS) Study, a study of community-living older men. We categorized individuals into tertiles of T50 and compared demographics and disease indicators across tertiles. We utilized linear regression to evaluate the cross-sectional association between T50 and hip and spine BMD in multivariable models. RESULTS Older age was associated with shorter T50. Kidney function tended to be lower in those with shorter T50 and the prevalence of CVD and peripheral arterial disease in those with shorter T50, albeit these findings did not achieve statistical significance. We found no statistically significant associations between T50 and total hip or total spine BMD in either unadjusted or multivariable adjusted models. CONCLUSIONS T50, a novel indicator of serum calcification propensity, is not associated with BMD in community-living older men. Future larger studies should determine if T50 may give insights to CVD in the general population above and beyond traditional risk factors.
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Affiliation(s)
- A L Bullen
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - C A M Anderson
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - E R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - E Orwoll
- Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - A Pasch
- Calciscon, Nidau, Biel, Switzerland
| | - J H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, USA.
- Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA.
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Stone KL, Blackwell T, Ancoli-Israel S, Ensrud KE, Kado DM, Wallace ML, Cawthon PM, Buysse DJ. SLEEP HEALTH AND FUNCTIONAL LIMITATIONS IN OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, United States
| | - T Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | | | - K E Ensrud
- University of Minnesota, Minneapolis, MN, USA
| | - D M Kado
- University of California, San Diego, CA, USA
| | - M L Wallace
- University of Pittsburgh, Pittsburgh, PA, USA
| | - P M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA, USA
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Stone KL, Blackwell T, Ancoli-Israel S, Ensrud KE, Kado DM, Wallace MJ, Cawthon PM, Redline S, Buysse DJ. 0702 Sleep Health and Risk of Prevalent and Incident Functional Limitations in Older Adults. Sleep 2018. [DOI: 10.1093/sleep/zsy061.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - T Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | | | - K E Ensrud
- University of Minnesota, Minneapolis, MN
| | - D M Kado
- University of California, San Diego, San Diego, CA
| | | | - P M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - S Redline
- Brigham and Women’s Hospital, Boston, MA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
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McDaniels-Davidson C, Davis A, Wing D, Macera C, Lindsay SP, Schousboe JT, Nichols JF, Kado DM. Kyphosis and incident falls among community-dwelling older adults. Osteoporos Int 2018; 29:163-169. [PMID: 29018904 DOI: 10.1007/s00198-017-4253-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits. INTRODUCTION To determine the association between four measures of kyphosis and incident and injurious falls in older persons. METHODS Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview. RESULTS Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls. CONCLUSIONS Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.
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Affiliation(s)
- C McDaniels-Davidson
- San Diego State University/University of California, San Diego | Joint Doctoral Program in Public Health (Epidemiology), San Diego, CA, USA.
| | - A Davis
- San Diego State University/University of California, San Diego | Joint Doctoral Program in Public Health (Epidemiology), San Diego, CA, USA
| | - D Wing
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - C Macera
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - S P Lindsay
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - J T Schousboe
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
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Katzman WB, Vittinghoff E, Lin F, Schafer A, Long RK, Wong S, Gladin A, Fan B, Allaire B, Kado DM, Lane NE. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 2017; 28:2831-2841. [PMID: 28689306 PMCID: PMC5873977 DOI: 10.1007/s00198-017-4109-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023]
Abstract
A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis. INTRODUCTION The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults. METHODS We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60-88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes. RESULTS There was a -3.0° (95% CI -5.2, -0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05. CONCLUSIONS Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis. TRIAL REGISTRATION NUMBER AND NAME OF TRIAL REGISTER ClinicalTrials.gov; identifier NCT01751685.
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Affiliation(s)
- W B Katzman
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - F Lin
- University of California, 550 16th. Street, San Francisco, CA, 94158, USA
| | - A Schafer
- University of California, 4150 Clement St, San Francisco, CA, 94121, USA
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA
| | - R K Long
- University of California, 550 16th. Street, San Francisco, CA, 94143, USA
| | - S Wong
- University of California, 1500 Owens Street, San Francisco, CA, 94158, USA
| | - A Gladin
- Kaiser Permanente Northern CA, San Francisco Medical Center, 1635 Divisadero Street, Suite 300, San Francisco, CA, 94115, USA
| | - B Fan
- University of California, 400 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - B Allaire
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - D M Kado
- University of California, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - N E Lane
- University of California, 4625 Second Avenue, Suite 2000, Sacramento, CA, 95616, USA
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Yamamoto J, Bergstrom J, Davis A, Wing D, Schousboe JT, Nichols JF, Kado DM. Trunk lean mass and its association with 4 different measures of thoracic kyphosis in older community dwelling persons. PLoS One 2017; 12:e0174710. [PMID: 28369088 PMCID: PMC5378351 DOI: 10.1371/journal.pone.0174710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 03/14/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The causes of age-related hyperkyphosis (HK) include osteoporosis, but only 1/3 of those most severely affected have vertebral fractures, suggesting that there are other important, and potentially modifiable causes. We hypothesized that muscle mass and quality may be important determinants of kyphosis in older persons. METHODS We recruited 72 persons >65 years to participate in a prospective study designed to evaluate kyphosis and fall risk. At the baseline visit, participants had their body composition measures completed using Dual Energy X-ray Absorptiometry (DXA). They had kyphosis measured in either the standing [S] or lying [L] position: 1) Cobb angle from DXA [L]; 2) Debrunner kyphometer [S]; 3) architect's flexicurve ruler [S]; and 4) blocks method [L]. Multivariable linear/logistic regression analyses were done to assess the association between each body composition and 4 kyphosis measures. RESULTS Women (n = 52) were an average age of 76.8 (SD 6.7) and men 80.5 (SD 7.8) years. They reported overall good/excellent health (93%), the average body mass index was 25.3 (SD 4.6) and 35% reported a fall in the past year. Using published cut-offs, about 20-30% were determined to have HK. For the standing assessments of kyphosis only, after adjusting for age, sex, weight and hip BMD, persons with lower TLM were more likely to be hyperkyphotic. CONCLUSIONS Lower TLM is associated with HK in older persons. The results were stronger when standing measures of kyphosis were used, suggesting that the effects of muscle on thoracic kyphosis are best appreciated under spinal loading conditions.
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Affiliation(s)
- J. Yamamoto
- University of Hawaii, Honolulu, Hawaii, United States of America
| | - J. Bergstrom
- University of California, San Diego, La Jolla, California, United States of America
| | - A. Davis
- University of California, San Diego, La Jolla, California, United States of America
| | - D. Wing
- University of California, San Diego, La Jolla, California, United States of America
| | - J. T. Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, Minnesota, United States of America
| | - J. F. Nichols
- University of California, San Diego, La Jolla, California, United States of America
| | - D. M. Kado
- University of California, San Diego, La Jolla, California, United States of America
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Fink HA, Litwack-Harrison S, Taylor BC, Bauer DC, Orwoll ES, Lee CG, Barrett-Connor E, Schousboe JT, Kado DM, Garimella PS, Ensrud KE. Erratum to: Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the osteoporotic fractures in men (MrOS) study. Osteoporos Int 2017; 28:419-420. [PMID: 27766366 PMCID: PMC5262150 DOI: 10.1007/s00198-016-3805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H A Fink
- Geriatric Research Education & Clinical Center, Minneapolis VA, Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA.
| | - S Litwack-Harrison
- Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd, floor, Box, San Francisco, CA, #0560, USA
| | - B C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA
| | - D C Bauer
- Department of Medicine, University of California, San Francisco, 1545 Divisadero St, 3rd Floor, San Francisco, CA, USA
| | - E S Orwoll
- Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA
| | - C G Lee
- Portland Veterans Affairs HealthCareSystem, 3710SWUSVeterans Hospital Rd, R&D45, Portland, OR, 97239, USA
| | - E Barrett-Connor
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - J T Schousboe
- Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA
| | - D M Kado
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - P S Garimella
- Division of Nephrology, Tufts Medical Center, 800 Washington, Street, Box 391, Boston, MA, 02111, USA
| | - K E Ensrud
- Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA
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Tran TH, Wing D, Davis A, Bergstrom J, Schousboe JT, Nichols JF, Kado DM. Correlations among four measures of thoracic kyphosis in older adults. Osteoporos Int 2016; 27:1255-1259. [PMID: 26475287 PMCID: PMC5332161 DOI: 10.1007/s00198-015-3368-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/06/2015] [Indexed: 02/02/2023]
Abstract
SUMMARY There are many ways to measure thoracic kyphosis ranging from simple clinical to more complex assessments. We evaluated the correlation among four commonly used kyphosis measures: Cobb angle, Debrunner kyphometer, kyphotic index, and the blocks method. Each measure was correlated with the others, confirming high clinical and research applicability. INTRODUCTION The purpose of this study was to assess the associations among four commonly used measures of thoracic kyphosis in older adults. METHODS Seventy two men and women aged 65-96 were recruited from the San Diego community. Four kyphosis measures were assessed in the same person during a baseline clinic visit. Two measures were done in the lying (L) and two in the standing (ST) position: (1) Cobb angle calculated from dual X-Ray absorptiometry (DXA) images (L), (2) Debrunner kyphometer (DK) angle measured by a protractor (ST), (3) kyphotic index (KI) calculated using an architect's flexicurve ruler (ST), and (4) the blocks method involving counting the number of 1.7 cm-thick blocks required to achieve a neutral head position while lying flat on the DXA table (L). Spearman rank correlation coefficients were used to determine the strength of the association between each kyphosis measure. RESULTS Using the Cobb angle as the gold standard, the blocks method demonstrated the lowest correlation (r(s) = 0.63, p < 0.0001), the Debrunner method had a moderate correlation (r(s) = 0.65, p < 0.0001), and the kyphotic index had the highest correlation (r(s) = 0.68, p < 0.0001). The correlation was strongest between the kyphotic index and the Debrunner kyphometer (r(s) = 0.76, p < 0.0001). CONCLUSION In older men and women, all four measures of thoracic kyphosis were significantly correlated with each other, whether assessed in the lying or standing position. Thus, any of these measures demonstrate both potential clinical and research utility.
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Affiliation(s)
- T H Tran
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D Wing
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - A Davis
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J Bergstrom
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J F Nichols
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - D M Kado
- Department of Family Medicine and Public Health, University of California at San Diego, 9500 Gilman Drive #0725, La Jolla, CA, 92093-0725, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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Katzman WB, Vittinghoff E, Kado DM, Lane NE, Ensrud KE, Shipp K. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int 2016; 27:899-903. [PMID: 26782685 PMCID: PMC4939887 DOI: 10.1007/s00198-015-3478-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/29/2015] [Indexed: 01/08/2023]
Abstract
SUMMARY Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. INTRODUCTION Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. METHODS We used data from the Fracture Intervention Trial among 3038 women 55-81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. RESULTS Mean baseline kyphosis was 48° (SD = 12) (range 7-83). At baseline, 962 (32%) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95% CI 2.8-4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22% increase (95% CI 8-38%, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8% per 10° kyphosis (95% CI -4 to 22%, p = 0.18). CONCLUSIONS While greater kyphosis increased the rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture.
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Affiliation(s)
- W B Katzman
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, 1500 Owens Suite 400, San Francisco, CA, 94158, USA.
| | - E Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - D M Kado
- Departments of Family and Preventive Medicine and Internal Medicine, University of California, San Diego, USA
- Department of Internal Medicine, University of California, Davis, USA
| | - N E Lane
- Department of Internal Medicine, University of California, Davis, USA
| | - K E Ensrud
- Minneapolis VA Health Care System, University of Minnesota, Minneapolis, USA
| | - K Shipp
- Division of Physical Therapy, Department of Community and Family Medicine, Duke University, Durham, USA
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Fink HA, Litwack-Harrison S, Taylor BC, Bauer DC, Orwoll ES, Lee CG, Barrett-Connor E, Schousboe JT, Kado DM, Garimella PS, Ensrud KE. Clinical utility of routine laboratory testing to identify possible secondary causes in older men with osteoporosis: the Osteoporotic Fractures in Men (MrOS) Study. Osteoporos Int 2016; 27:331-8. [PMID: 26458388 PMCID: PMC4719570 DOI: 10.1007/s00198-015-3356-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED We investigated the value of routine laboratory testing for identifying underlying causes in older men diagnosed with osteoporosis. Most osteoporotic and nonosteoporotic men had ≥1 laboratory abnormality. Few individual laboratory abnormalities were more common in osteoporotic men. The benefit of routine laboratory testing in older osteoporotic men may be low. INTRODUCTION To evaluate the utility of recommended laboratory testing to identify secondary causes in older men with osteoporosis, we examined prevalence of laboratory abnormalities in older men with and without osteoporosis. METHODS One thousand five hundred seventy-two men aged ≥65 years in the Osteoporotic Fractures in Men study completed bone mineral density (BMD) testing and a battery of laboratory measures, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), 25-OH vitamin D, total testosterone, spot urine calcium/creatinine ratio, spot urine albumin/creatinine ratio, creatinine-derived estimated glomerular filtration rate, 24-h urine calcium, and 24-h urine free cortisol. Using cross-sectional analyses, we calculated prevalence ratios (PRs) and 95 % confidence intervals (CI) for the association of any and specific laboratory abnormalities with osteoporosis and the number of men with osteoporosis needed to test to identify one additional laboratory abnormality compared to testing men without osteoporosis. RESULTS Approximately 60 % of men had ≥1 laboratory abnormality in both men with and without osteoporosis. Among individual tests, only vitamin D insufficiency (PR, 1.13; 95 % CI, 1.05-1.22) and high alkaline phosphatase (PR, 3.05; 95 % CI, 1.52-6.11) were more likely in men with osteoporosis. Hypercortisolism and hyperthyroidism were uncommon and not significantly more frequent in men with osteoporosis. No osteoporotic men had hypercalciuria. CONCLUSIONS Though most of these older men had ≥1 laboratory abnormality, few routinely recommended individual tests were more common in men with osteoporosis than in those without osteoporosis. Possibly excepting vitamin D and alkaline phosphatase, benefit of routine laboratory testing to identify possible secondary causes in older osteoporotic men appears low. Results may not be generalizable to younger men or to older men in whom history and exam findings raise clinical suspicion for a secondary cause of osteoporosis.
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Affiliation(s)
- H A Fink
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN, 55417, USA.
| | - S Litwack-Harrison
- Department of Epidemiology & Statistics, University of California, San Francisco, San Francisco Coordinating Center, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd floor, Box #0560, San Francisco, CA, USA
| | - B C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Mail code 152, Building 9, Minneapolis, MN, 55417, USA
| | - D C Bauer
- Department of Medicine, University of California, San Francisco, 1545, Divisadero St, 3rd Floor, San Francisco, CA, USA
| | - E S Orwoll
- Bone & Mineral Unit, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR113, Portland, OR, 97239, USA
| | - C G Lee
- Portland Veterans Affairs Health Care System, 3710 SW US Veterans Hospital Rd, R&D45, Portland, OR, 97239, USA
| | - E Barrett-Connor
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - J T Schousboe
- Health Research Center, Park Nicollet Institute for Research and Education, 3800 Park Nicollet Boulevard, Minneapolis, MN, 55416, USA
| | - D M Kado
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - P S Garimella
- Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA, 02111, USA
| | - K E Ensrud
- Division of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive, 111-0, Minneapolis, MN, 55417, USA
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Katzman WB, Vittinghoff E, Kado DM. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteoporos Int 2011; 22:85-90. [PMID: 20480146 PMCID: PMC2958231 DOI: 10.1007/s00198-010-1265-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 03/09/2010] [Indexed: 10/25/2022]
Abstract
UNLABELLED While many assume hyperkyphosis reflects underlying spinal osteoporosis and vertebral fractures, our results suggest hyperkyphosis is independently associated with decreased mobility. Hyperyphosis is associated with slower Timed Up and Go performance times and may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk. INTRODUCTION While multiple studies have demonstrated negative effects of hyperkyphosis on physical function, none have disentangled the relationship between hyperkyphosis, impaired function, and underlying spinal osteoporosis. The purpose of this study is to determine whether kyphosis, independent of spinal osteoporosis, is associated with mobility on the Timed Up and Go, and to quantify effects of other factors contributing to impaired mobility. METHODS We used data for 3,108 community-dwelling women aged 55-80 years in the Fracture Intervention Trial. All participants had measurements of kyphosis, mobility time on the Timed Up and Go test, height, weight, total hip bone mineral density (BMD), grip strength, and vertebral fractures at baseline visits in 1993. Demographic characteristics included age and smoking status. We calculated mean Timed Up and Go time by quartile of kyphosis. Using multivariate linear regression, we estimated the independent association of kyphosis with mobility time, and quantified effects of other covariates on mobility. RESULTS Mean mobility time increased from 9.3 s in the lowest to 10.1 s in the highest quartile of kyphosis. In a multivariate-adjusted model, mobility time increased 0.11 s (p = 0.02) for each standard deviation (11.9°) increase in kyphosis. Longer performance times were significantly associated with increasing age, decreasing grip strength, vertebral fractures, body mass index ≥25, and total hip BMD in the osteoporotic range. CONCLUSIONS Kyphosis angle is independently associated with decreased mobility on the Timed Up and Go, which is in turn correlated with increased fall risk. Hyperkyphosis may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk.
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Affiliation(s)
- W B Katzman
- University of California, San Francisco, UCSF Box 0625, San Francisco, CA 94143-0625,
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Kado DM. The rehabilitation of hyperkyphotic posture in the elderly. Eur J Phys Rehabil Med 2009; 45:583-593. [PMID: 20032918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The angle of thoracic kyphosis tends to increase with age resulting in hyperkyphosis in some individuals. While the term "kyphotic" is occasionally used to describe someone with accentuated thoracic curvature, hyperkyphosis is preferred since kyphosis itself refers to the normal sagittal angle of thoracic curvature. Epidemiolo-gic studies have demonstrated that age-related hyperkyphosis commonly affects the elderly population with estimates ranging from 20% to 40%. In addition, hyperkyphosis affects a substantial number of older men. Apart from being a cosmetic deformity, older persons who suffer from hyperkyphosis are at increased risk for a variety of adverse health outcomes that include poor physical function, pulmonary compromise, falls, fractures, and even earlier mortality. Most clinicians and patients have assumed that thoracic hyperkyphosis is a result of underlying spinal osteoporosis, but approximately two thirds of those who are most hyperkyphotic don't have vertebral fractures. Over the past few years, there has been increased awareness and focus on potential effective treatments for age-related hyperkyphosis. Of these treatments, exercise based interventions and spinal orthoses are conservative rehabilitation management techniques that have shown promise in potentially improving health outcomes for affected patients. To date, all of these types of trials have been small in scale, and most short in duration. In the future, larger rigorously designed clinical trials will be needed to test and confirm the efficacy and feasibility of the most promising treatments for age-related hyperkyphosis. This invited review will discuss hyperkyphosis in terms of its etiology, clinical associations, and treatment in elderly individuals.
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Affiliation(s)
- D M Kado
- Department of Orthopedic Surgery, UCLA Orthopaedic Hospital, Los Angeles, CA 90095, USA.
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Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, Cummings SR. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 2003; 14:589-94. [PMID: 12827222 DOI: 10.1007/s00198-003-1412-5] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2002] [Accepted: 02/19/2003] [Indexed: 10/26/2022]
Abstract
Older persons who have prevalent vertebral fractures have an increased risk of mortality. It is not known whether incident vertebral fractures are also associated with an increased risk of mortality. To determine whether older women with incident vertebral fractures have an increased risk of mortality, we conducted a prospective cohort study of 7233 community-dwelling older women aged 65 years or older who were enrolled in the Study of Osteoporotic Fractures. We measured incident vertebral fractures by radiographic morphometry of paired lateral spine X-rays taken an average of 3.7 years apart. We also collected information on baseline prevalent vertebral fractures; calcaneal bone density; anthropometric measures; and demographic, medical history, and lifestyle variables. Overall mortality was assessed and confirmed by receipt of death certificates. Over an average of 3.7 years, 389 (5.4%) women developed at least one incident vertebral fracture. During an additional 8 years of follow-up, 1617 (22%) women died. Women with at least one new fracture had an age-adjusted 32% increased risk of mortality (RH=1.32; 95% CI=1.10-1.58, P=0.003) compared to those without incident vertebral fractures. After adjustment for weight loss, physical frailty markers, and nine other predictors of mortality, there was no longer an independent association between incident vertebral fractures and mortality (RH=1.06; 95% CI=0.88 1.28). Older women with incident vertebral fractures have an increased risk of mortality that may be explained by weight loss and physical frailty.
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Affiliation(s)
- D M Kado
- Division of Geriatrics, Department of Medicine, The David Geffen School of Medicine at University of California, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
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Shipp KM, Guess HA, Ensrud KE, Nevitt MC, Kado DM, Cummings SR. THORACIC KYPHOSIS AND RATE OF INCIDENT VERTEBRAL FRACTURE. J Geriatr Phys Ther 2002. [DOI: 10.1519/00139143-200225030-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Older women with low bone density have an increased risk of fracture, cardiovascular disease, and mortality. However, it is not known whether this association is caused by ongoing bone loss or by lower bone mass earlier in life. To determine whether rate of bone loss is associated with total and cause-specific mortality, we prospectively studied 6046 women aged 65 years or older who had serial bone mineral density (BMD) measurements as a part of the Study of Osteoporotic Fractures. Rates (mean +/- SD) of loss of BMD at the heel (for a mean of 5.7 years) and hip (for a mean of 3.5 years) were estimated. Cause-specific mortality was ascertained from death certificates and hospital records. BMD loss at the heel was 5.9 +/- 6.0 mg/cm2 per year (1.5 +/- 1.5%) and BMD loss at the hip was 4.1 +/- 10.2 mg/cm2 per year (0.6 +/- 1.4%). During an average follow-up of 3.2 years after the second measurement of BMD, 371 deaths occurred. Each SD increase in BMD loss at the hip was associated with a 1.3-fold (95% CI, 1.1-1.4) increase in total mortality, adjusted for age, baseline BMD, diabetes, hypertension, incident fractures, smoking, physical activity, health status, weight loss, and calcium use. In particular, hip BMD loss was associated with increased mortality from coronary heart disease (relative hazard [RH] = 1.3 per SD; 95% CI, 1.0-1.8) and pulmonary diseases (RH = 1.6 per SD; 95% CI, 1.1-2.5). The findings were similar for bone loss at the heel, except there was no significant association with pulmonary mortality. These results raise the possibility that bone loss may share common etiologies with coronary and pulmonary diseases.
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Affiliation(s)
- D M Kado
- Department of Medicine, University of California at Los Angeles, 90095, USA
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Ensrud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, Santora AC, Black DM. Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 2000; 48:241-9. [PMID: 10733048 DOI: 10.1111/j.1532-5415.2000.tb02641.x] [Citation(s) in RCA: 303] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the relationship between prevalent vertebral deformities and the risk of mortality and hospitalization in older women with low bone mass. DESIGN A prospective cohort study. SETTING Eleven clinical centers in the United States. PARTICIPANTS A total of 6459 community-dwelling women with low bone mass aged 55 to 81 participated in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate that enrolled women into one of two study arms based solely on the presence or absence of existing radiographic vertebral deformities. There were 2027 women with at least one vertebral deformity enrolled in the vertebral fracture arm of FIT and followed prospectively for an average of 2.9 years, whereas 4432 women with no vertebral deformity were enrolled in the clinical fracture arm of FIT and followed prospectively for an average of 4.2 years. MEASUREMENTS Determination of prevalent vertebral deformities on baseline lateral thoracic and lumbar spine radiographs was made at the coordinating center using a combination of radiographic morphometry by digitization and semiquantitative radiologic interpretation. Deaths were confirmed by obtaining copies of original death certificates of all participants who died. Episodes of hospitalization were captured through adverse event reporting; hospitalizations resulting solely from adverse events containing the words "fracture" or "trauma" were excluded from the analyses. RESULTS During the follow-up period, 122 women died, and 1676 women were hospitalized on at least one occasion for reasons not related solely to fracture. Compared with women without prevalent vertebral deformities, those women with prevalent deformities had higher risks of mortality (age- and treatment assignment-adjusted relative risk 1.60, 95% confidence interval (CI), 1.10-2.32) and hospitalization (age- and treatment assignment-adjusted relative risk 1.18, 95% CI, 1.06-1.31). In addition, further adjustment for other factors, including smoking status, physical activity, hypertension, coronary heart disease, obstructive lung disease, any fracture since the age of 50, health status, total hip BMD, and body mass index did not alter the association between prevalent vertebral deformities and risk of mortality substantially (multivariate relative risk 1.49, 95% CI, 1.05-2.21). Adjustment for all these factors and diabetes also did not change the relationship between prevalent vertebral deformities and hospitalization (multivariate relative risk 1.14, 95% CI, 1.02-1.27). Rates of mortality and hospitalization increased with increasing number of prevalent vertebral deformities (tests for trend P < .01). CONCLUSIONS Prevalent vertebral deformities in older women with low bone mass are associated with increased risks of mortality and hospitalization. Only a portion of this increased risk was explained by other known predictors of these outcomes.
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Affiliation(s)
- K E Ensrud
- Minneapolis Veterans Affairs Medical Center, Department of Medicine, University of Minnesota, 55417, USA
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Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999; 159:1215-20. [PMID: 10371229 DOI: 10.1001/archinte.159.11.1215] [Citation(s) in RCA: 678] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Osteoporotic fractures, including clinically detected vertebral fractures, are associated with increased mortality. However, only one third of vertebral fractures are diagnosed. It is unknown whether vertebral fractures, whether clinically apparent or not, are associated with greater mortality. OBJECTIVES To test the hypothesis that women with prevalent vertebral fractures have greater mortality than those without fractures and to describe causes of death associated with vertebral fractures. DESIGN Prospective cohort study with mean follow-up of 8.3 years. SETTING Four clinical centers in the United States. PARTICIPANTS A total of 9575 women aged 65 years or older and enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS Vertebral fractures by radiographic morphometry; calcaneal bone mineral density; demographic, medical history, and lifestyle variables; blood pressure; and anthropometric measures. In a subset of 606 participants, thoracic curvature was measured during a second clinic visit. MAIN OUTCOME MEASURES Hazard ratios for mortality and cause-specific mortality. RESULTS At baseline, 1915 women (20.0%) were diagnosed as having vertebral fractures. Compared with women who did not have a vertebral fracture, women with 1 or more fractures had a 1.23-fold greater age-adjusted mortality rate (95% confidence interval, 1.10-1.37). Mortality rose with greater numbers of vertebral fractures, from 19 per 1000 woman-years in women with no fractures to 44 per 1000 woman-years in those with 5 or more fractures (P for trend, <.001). In particular, vertebral fractures were related to the risk of subsequent cancer (hazard ratio, 1.4;95% confidence interval, 1.1-1.7) and pulmonary death (hazard ratio, 2.1;95% confidence interval, 1.4-3.0). In the subset of women who underwent thoracic curvature measurements, severe kyphosis was also related to pulmonary deaths (hazard ratio, 2.6;95% confidence interval, 1.3-5.1). CONCLUSION Women with radiographic evidence of vertebral fractures have an increased mortality rate, particularly from pulmonary disease and cancer.
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Affiliation(s)
- D M Kado
- Department of Medicine, University of California at Los Angeles, 90095, USA.
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