Impaired functional status increases fracture incidence in 10-year follow-up: the results from RAC-OST-POL Study

Elsevier

Available online 17 December 2022

Journal of Clinical DensitometryAuthor links open overlay panelAbstractIntroduction

. The aim of study was to establish the influence of baseline functional status on fracture incidence.

Methodology

. In a prospective 10-years observation in epidemiological sample of postmenopausal women from RAC-OST-POL Study a thesis that affected functional status enhance fracture incidence was verified. At baseline, data were collected in 978 women at mean age 66.48±7.6 years and after 10 years of follow-up 640 subjects at mean age 75.04±6.95 years remained in the study. Functional status at baseline was established using Stand up and Go test (SAG) and Activity of Daily Living (IADL). Afterwards, annually data on fracture incidence were collected by phone interviews.

Results

. In the period of observation 190 low-energy fractures in 129 women were noted. The whole group was divided into subgroups: without fracture (n=511), with one fracture (n=91) and those ones who had more than one fracture (n=38). In fractured and unfractured subgroup mean SAG results were 11.36±4.28 and 10.36±2.76, respectively and differed significantly (p<0.01). With increasing number of fractures the SAG time was longer – it was 11.15±4.49 in one fracture subgroup and 11.87±3.73 in multiple fractures subgroup, with both values significantly higher than in no fracture subjects. The mean value of IADL was 23.56±1.60. In 576 (90%) women IADL reached maximal value of 24 points. In the rest of them (n=64) IADL score was between 11 and 23 points. Mean value of IADL in fractured and unfractured subgroup were 23.27±1.97 and 23.64±1.47, respectively and differed significantly (p<0.01).

Conclusion

. The measures of functional status predict fractures in a prospective observation of representative epidemiological female sample.

Introduction

Osteoporosis is one of the most common diseases in elderly subjects. The role of osteoporosis depends mainly on late consequence of bone loss eg. fractures. The process of bone loss occurs without any clinical symptoms for long time, thus osteoporosis is called ‘silent bone thief’. The number of affected individuals allow to determine osteoporosis as ‘silent epidemic’. Lifetime fracture risk in females is close to 40%1. Fractures of forearm, arm, spine and hip are the most common and these fracture localizations are classified as ‘major osteoporotic fractures’. One should remember that prior fracture significantly increases the risk of subsequent fracture. This risk is approximately doubled after forearm fracture and may increase even 4-6 times after the spine or hip fracture2. Therefore, the most important goal in patients’ management is to avoid the first fracture.

Several fracture risk factors are identified and among them there are modifiable and unmodifiable ones. The most important clinical risk factors are: advanced age, female sex, prior low-energy fracture, steroid use, smoking and impaired functional status. Generally, fractures are related to the degree of bone loss and functional status. The role of osteoporosis as a risk factor for fracture is widely known3 and the significance of functional status is less studied. The process of bone loss may be easily measured using bone densitometry and such assessment is commonly performed in patients. Despite several methods designed in order to establish functional status are known4, 5, 6, 7, their implementation in daily practice is far from optimal level. We consider that such assessment should be always included in diagnostic armentarium, especially in elderly subjects. Methods proposed for daily practice should be easy to perform and validated as reliable diagnostic tool with potential to identify subjects at high fracture risk. One of relatively commonly used method is Stand up and Go test (SAG)6. In our previous cross-sectional study we noted that in epidemiological female sample of RAC-OST-POL study longer duration of SAG increased fracture incidence8. In the same study it was also shown that the result of Activity of Daily Living (IADL) is also related to fracture incidence8.

In current study we present the results of 10-years follow-up in order to verify the thesis that baseline functional status may indicate subjects with increased fracture risk.

Section snippetsMaterial

In the study the observation of epidemiological female sample of RAC-OST-POL cohort was performed. The baseline observation was carried out in 2010 and epidemiological data were presented earlier9. Briefly, in the cooperation with the local government 10% of all women older than 55 years living in the district of Racibórz were randomly selected from the whole population. A total number of 1753 women were invited to participate in the study. A group of 625 women responded positively to the

Results

In the period of observation 190 low-energy fractures in 129 women were noted. They were located at following skeletal sites: forearm - 81, spine - 30, ankle - 25, hip - 15, arm - 13, rib - 9, feet - 7, clavicula - 7 and pelvis – 3. In some patients there were observed more than one fracture and the whole group was divided into subgroups: without fracture (n=511), with one fracture (n=91) and those ones who had more than one fracture, namely between two and five (n=38).

Mean value for SAG in

Discussion

The most significant finding derived from current study is the observation that functional status established in an epidemiological female sample is related with fracture incidence in the long-term observation. It is an important information supporting the role of assessment of functional status in postmenopausal women. Each patient may benefit from such measure and noted abnormalities in functional status should be adequately corrected in order to avoid subsequent fracture. The results

Delcaration of interest

none

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© 2022 The International Society for Clinical Densitometry. Published by Elsevier Inc.

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