MedWire News: Researchers have identified two factors that predict reduced activities of daily living (ADL) in elderly individuals who suffer an osteoporotic vertebral fracture.
Writing in Spine, Tomiya Matsumoto (Osaka City University, Japan) and co-authors reveal that the presence of middle column injury of the fractured vertebral body, as well as a previous lack of regular exercise, each predicted reduced ADL at 6 months post-fracture.
"These findings are helpful in determining treatment options for patients with osteoporotic vertebral fractures," Matsumoto et al suggest.
The team prospectively studied 310 patients (mean age 75.8 years, 266 women) with osteoporotic vertebral fracture who were treated conservatively, most often with a corset.
In all, 36 patients (11.6%) reported a history of steroid use, 44 patients (14.2%) developed additional fractures during follow-up, and five patients (1.6%) needed vertebroplasty or decompression surgery.
Patients were assessed at baseline and at 6 months post-fracture. Each time, they were assigned to one of four functional grades: fully independent; requires assistance to leave home; nearly bedridden; or completely bedridden.
The researchers defined a reduction in ADL as a deterioration of at least one grade.
Before fracture, the vast majority of patients (93.9%) were living independently. At 6-month follow-up, however, this proportion had declined to 74.8%.
Of the remainder, 58 patients (18.7%) required assistance leaving home, 16 patients (5.2%) were nearly bedridden, and four patients (1.3%) were completely bedridden.
This meant that 21.3% of the cohort experienced a reduction in ADL following vertebral fracture.
In multivariate analysis, two factors were significant independent predictors for reduced ADL: the presence of a middle column injury (odds ratio [OR]=2.26) and lack of regular exercise before fracture (OR=2.49).
The authors remark: "Osteoporotic vertebral fracture has severe effects on ADL and quality-of-life in elderly patients and can be the beginning of a long-lasting deterioration in health.
They believe that the prognostic factors they identified could help minimize this deterioration, suggesting: "Other treatment options such as vertebroplasty in addition to conventional conservative treatment might thus be necessary in the early stage after fracture for patients showing these prognostic factors."
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