Associations of self-reported height loss and kyphosis with vertebral fractures in Japanese women 60 years and older: a cross-sectional survey

Abstract

Some vertebral fractures come to clinical attention but most do not. This cross-sectional survey aimed to clarify the associations of self-reported height loss and kyphosis with vertebral fractures. We enrolled 407 women aged 60–92 years who visited our orthopaedic clinic between June and August 2014 in our study. Inclusion criteria were lateral radiography followed by completion of a structured questionnaire in this study. The primary outcome was vertebral fracture diagnosed on lateral radiography and graded using a semiquantitative grading method, from SQ0 (normal) to SQ3 (severe). Self-reported kyphosis was defined as none, mild to moderate, severe. Self-reported height loss was defined as <4 cm or ≥4 cm. Number of SQ1 fracture was associated only with kyphosis. Self-reported severe kyphosis was significantly associated with increased numbers of ≥SQ2 vertebral fractures (p = 0.007). Height loss ≥4 cm was significantly associated with increased ≥SQ2 grade fractures (p < 0.001). Odds ratios (ORs) for fractures associated with mild-to-moderate and severe kyphosis were 2.1 [95% confidence interval 1.4 to 3.3) and 4.2 (1.8 to 9.5), respectively. OR for fractures associated with height loss ≥4 cm was 2.3 (1.4 to 3.7). Self-reported kyphosis may be useful for identifying Japanese women aged ≥60 years who have undetected vertebral fractures.

Delayed wound healing after tooth extraction and self-reported kyphosis in Japanese men and women

“…In a previous study, patients who self-reported mild-to-moderate and severe kyphosis had a higher risk of vertebral fractures (OR 2.1; 95% CI, 1.4–3.3 and OR 4.2; 95% CI, 1.8–9.5, respectively)14. These findings suggest that subjects with vertebral fractures might have an increased risk of delayed wound healing.…”

“…The association between self-reported kyphosis and risk of having vertebral fractures in women, but not in men, was recently demonstrated14. The prevalence of Japanese OP patients aged ≥40 years was 3.4% of men and 19.2% of women31.…”

“…The structured questionnaire aimed at collecting the following information: presence of problematic delayed wound healing after last tooth extraction, self-reported kyphosis, number of teeth lost throughout the patient’s lifetime, self-reported periodontal condition, daily number of tooth brushing, history of smoking, history of diabetes mellitus, steroid use, rheumatoid arthritis, and time of last tooth extraction (<1 year, 1–3 years, >3 years). Self-reported kyphosis was defined using three categories as previously described14: none, mild-moderate, and severe. Self-reported periodontal condition was divided into two categories: no periodontal symptom and some symptoms like bleeding (with and without brushing), swelling and/or tooth mobility according to our previous study32.…”

“…Approximately two thirds of women with radiographic evidence of vertebral fracture are unaware of the fracture13. However, we recently demonstrated that a self-reported kyphosis may be a useful marker for identifying postmenopausal women with asymptomatic vertebral fractures14. Therefore, in this study, we evaluated the association between self-reported experience of delayed wound healing after tooth extraction and self-reported kyphosis, which represents the potential presence of vertebral fractures, in Japanese men and women.…”

Spinal radiographs in those with back pain—when are they appropriate to diagnose vertebral fractures?

“…In addition, cumulative corticosteroid dosage is associated with vertebral fractures, independent of bone density [24,25,28]. More than 4 cm difference between height at age 25 and current height has been associated with vertebral fractures in several studies [19,29]. Current smoking may be an important risk factor [30], with men and those who have developed Chronic Obstructive Pulmonary Disease (COPD) being at particular risk of vertebral fractures [31].…”