Undiagnosed Vertebral Fractures Influence Quality of Life in Postmenopausal Women With Reduced Ultrasound Parameters

Abstract

Background Osteoporosis, a multifactorial systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to increased bone fragility, is a worldwide public health problem. Vertebral fractures affect approximately 20% of postmenopausal women and are a hallmark of osteoporosis, but they may pass unnoticed, although they may lead to long-term immobility and disability. Questions/purposes The aims of the present study were (1) to determine the prevalence and the severity of vertebral fractures in a large cohort of Italian women aged 60 years or older with reduced values of quantitative ultrasound parameters; and (2) to assess whether vertebral fractures and other variables may be associated with health-related quality of life. Methods A total of 2450 women without back pain aged 60 years or older, after the completion of the Quality of Life Questionnaire of the European Foundation for Osteoporosis QUALEFFO, underwent quantitative ultrasound evaluation of the calcaneus; in those with a stiffness t-score of B À2 (n = 1194), radiographic evaluation of the thoracic and lumbar spine was carried out and then quantitative morphometry was performed by dedicated software (MorphoXpress). The radiographic analysis was carried out on 885 women who presented films of adequate quality. Multivariate regression was used to adjust for confounding variables. Results Of those who underwent radiographic analysis, 681 had no vertebral fractures, and 204 women (23.1%) had one or more previously undiagnosed vertebral fractures. The prevalence of previously undiagnosed vertebral fractures increased with advancing age with more than 30% of women older than 75 years having at least one fracture. Older age, body mass index, and severe vertebral fractures were independently associated with a worse total QUALEFFO score. Conclusions We found that approximately one in four women showed evidence of undiagnosed vertebral fractures, and there was a strong age effect trend. Moreover, the severity grade of vertebral fractures, more than the number of fractures, was associated with a worsening of healthrelated quality of life as assessed by QUALEFFO. These findings confirm the clinical relevance of an early diagnosis of vertebral fractures and seem to support the usefulness of quantitative ultrasound measurements in the stratification of postmenopausal women at increased fracture risk.

Vertebral fractures and their association with health-related quality of life, back pain and physical function in older women

“…VFs are associated with back pain, disability, impaired quality of life, morbidity and mortality [ 6 – 8 ]. In a recent meta-analysis of older osteoporotic patients with and without VFs the physical and mental health-related quality of life (HRQL) was reported to be worse in people with VF [ 9 ].…”

“…Thus, VFA is a method that can be applied in conjunction with a standard clinical osteoporosis evaluation, to diagnose VFs with very little additional radiation and at low cost. Most previous studies investigating associations between prevalent VF and quality of life, morbidity and mortality have used conventional spine radiography to identify fractures [ 6 – 8 ]. Among the studies, reporting use of VFA to diagnose prevalent VFs, just a few have been population-based [ 16 – 18 ].…”

The Diagnostic Value of Magnetic Resonance Imaging in Identifying Unsuspected Malignancy in Patients Undergoing Percutaneous Vertebral Augmentation for Vertebral Compression Fractures

“…Vertebral compression fractures (VCFs) occur in up to 20% of postmenopausal women and can lead to chronic, decreased quality of life and increased mortality. 1,2 Osteoporosis is presumed to be the main cause of VCF in most cases. Percutaneous vertebral augmentation procedures (PVAPs), such as percutaneous vertebroplasty and kyphoplasty, are minimally invasive treatment options in the management of VCF unresponsive to conservative options.…”

Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study

“…One‐third of all vertebral fractures are never clinically diagnosed due to symptoms being absent or missed . Although osteoporotic vertebral fractures may pass unnoticed, they may lead to long‐term immobility and disability . Dual energy X‐ray absorptiometry (DEXA) method measures bone mineral density (BMD).…”