The Association Between Fractures, Posture and Physical Performance Measures in Women Over the Age of 65

Background Information: Vertebral fractures are a common type of osteoporotic fracture, associated with increased morbidity and mortality. An accumulation of vertebral fractures may lead to postural changes including hyperkyphosis. However, hyperkyphosis may also be caused from habitual forward flexion and weakening of the back extensor muscles. The associations between vertebral fractures, posture and physical performance remain unclear.

Objectives: Our primary objective was to investigate the association between number, severity, and location of vertebral fractures (vertebral fracture characteristics), or posture (OWD) and performance on the Timed Up and Go (TUG) test. Secondary objectives were to understand the association between vertebral fracture characteristics or OWD and other physical performance measures; and between vertebral fracture characteristics and OWD. Methods: We used baseline data from a multi-site randomized controlled trial of women over the age of 65 with a suspected vertebral fragility fracture. SPSS was used to run multivariable regression models to evaluate relationships between variables for each objective. A p-value of <0.05 was considered statistically significant. Both adjusted and unadjusted models were generated, where the adjusted model accounted for age, and pain.

Results: A total of 158 women were included in the study. The mean age (SD), BMI (SD), OWD (SD), and number of fractures was 75.9 (6.5) years, 26.7 (5.3) kg/m², 5.7 (4.6) cm, and 2.5 (2.4), respectively. OWD (B=0.25 95% CI= 0.12,0.38) and pain (B=0.32 95% CI=0.10,0.53) were independently associated with TUG, four-meter walk (OWD: B=0.08 95% CI=0.03,0.12; pain: B=0.11 95% CI=0.04,0.18), and step test (OWD: B= -0.33 95% CI=-0.47,-0.19; pain: B= -0.29 95% CI=-0.51,-0.07). OWD was independently associated with five times sit-to-stand (B=0.29 95% CI=0.07,0.50). Severity of fracture was independently associated with four-meter walk test. Number of fractures (B=0.82 95% CI=0.04-1.59) and pain (B=0.30 95% CI=0.04,0.56) were independently associated with OWD.

Conclusion: OWD was significantly associated with each of the physical performance tests, and contributed more to physical performance variability than number, severity and location of fracture.

Keywords: hyperkyphosis; vertebral fractures; osteoporosis; occiput-to-wall distance; older adults; physical performance

Year	Entry
2015	Prior JC, Langsetmo L, Lentle BC, Berger C, Goltzman D, Kovacs CS, Kaiser SM, Adachi JD, Papaioannou A, Anastassiades T, Towheed T, Josse RG, Brown JP, Leslie WD, Kreiger N; CaMOS Research Group. Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study: comparing site and age-specific risks in women and men. Bone. February 2015;71:237-243.
1999	Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int. September 1999;10(3):214-221.
1995	Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. November 1995;17(5)(suppl 1):S505-S511.
1992	Cooper C, Atkinson EJ, O'Fallon WM, Melton JL III. Incidence of clinically diagnosed vertebral fractures: a population‐based study in Rochester, Minnesota, 1985‐1989. J Bone Miner Res. February 1992;7(2):221-227.
2003	Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. October 2003;33(4):522-532.
2008	Seeman E. Bone quality: the material and structural basis of bone strength. J Bone Min Metab. 2008;26(1):1-8.
2005	Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int. June 2005;16(6):581-589.
1995	McCubbrey DA, Cody DD, Peterson EL, Kuhn JL, Flynn MJ, Goldstein SA. Static and fatigue failure properties of thoracic and lumbar vertebral bodies and their relation to regional density. J Biomech. August 1995;28(8):891-899.
1991	Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. February 1991;39(2):142-148.
1998	Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. May 15, 1998;128(10):793-800.
1990	Adams MA, Dolan P, Hutton WC, Porter RW. Diurnal changes in spinal mechanics and their clinical significance. J Bone Joint Surg. March 1990;72B(2):266-270.
2002	Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. June 1, 2002;359(9321):1929-1936.
2003	Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas P. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone. January 2003;32(1):78-85.
1999	Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW; European Vertebral Osteoporosis Study Group. Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int. March 1999;9(3):206-213.
1989	Melton LJ III, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. May 1989;129(5):1000-1011.
2001	Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E. Risk of new vertebral fracture in the year following a fracture. JAMA. January 17, 2001;285(6):320-323.
1989	Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA. May 12, 1989;261(18):2663-2668.
2010	Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD; Scientific Advisory Council of Osteoporosis Canada. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Can Med Assoc J. November 23, 2010;182(17):1864-1873.
1996	Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR; The Study of Osteoporotic Fractures Research Group. Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res. July 1996;11(7):984-996.
2001	Banse X, Devogelaer JP, Munting E, Delloye C, Cornu O, Grynpas M. Inhomogeneity of human vertebral cancellous bone: systematic density and structure patterns inside the vertebral body. Bone. 2001;28(5):563-571.

Year

Entry

2015

Prior JC, Langsetmo L, Lentle BC, Berger C, Goltzman D, Kovacs CS, Kaiser SM, Adachi JD, Papaioannou A, Anastassiades T, Towheed T, Josse RG, Brown JP, Leslie WD, Kreiger N; CaMOS Research Group. Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study: comparing site and age-specific risks in women and men. Bone. February 2015;71:237-243.

1999

Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int. September 1999;10(3):214-221.

1995

Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. November 1995;17(5)(suppl 1):S505-S511.

1992

Cooper C, Atkinson EJ, O'Fallon WM, Melton JL III. Incidence of clinically diagnosed vertebral fractures: a population‐based study in Rochester, Minnesota, 1985‐1989. J Bone Miner Res. February 1992;7(2):221-227.

2003

Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. October 2003;33(4):522-532.