Background Epidemiological studies have identified risk factors for falling and fractures. However there is a paucity of observational studies1,2 of patients with symptomatic fragility vertebral compression fractures (VCF). These studies were not done in community based populations and did not evaluate the contribution of falling.
Objectives To study factors contributing to both osteoporosis and falling in a cohort of community based patients with symptomatic subacute fragilty VCF.
Methods We saw 128 patients with symptomatic subacute fragility VCF in our community based outpatient fracture clinic over a two year period. We performed a complete history and physical, review of past medical records and radiographs, complete blood count, sedimentation rate, chemistry profile, TSH, urinalysis, vitamin B-12, PTH, 25-OH vitamin D, and serum protein electrophoresis (SPE). We performed testosterone level, methylmalonic acid, antiparietal cell antibody and intrinsic factor antibody in select cases. We recorded diseases including diabetes, COPD, cardiac, neurological for each patient.
Results There were 92 females aged 45–98 years (mean 77.7), 36 males aged 39–94 years (mean 77.6). Factors contributing to falling included peripheral neuropathy-61, use of sedatives-43, blindness-12, foot drop-6, dementia-3, Parkinson's-3, hyponatremia-2. VCF were precipitated by falls in 94 patients, of which 87 occurred at home. VCF occurred with lifting in 8 patients, bending in 3, and were spontaneous in 23. Use of steroids was reported in 18 patients and associated with mulitple (>3) fractures (p<0.0008). Blindness (p=0.022) and multiple fractures (p=0.049) were found more often among females. Males were more likely to have peripheral neuropathy (p=0.056) and 3 or more medical conditions (P<0.008). Age correlated with the number of diseases (p<0.0001). Diagnosis based on laboratory studies included vitamin D insufficiency-29, vitamin D deficiency-12, pernicious anemia-6, vitamin B-12 deficiency-8, monoclonal gammopathy of uncertain significance (MGUS)-10, myeloma-2, hypogonadism-12, and iatrogenic hyperthyroidism-3. Ankylosing spondylitis and lymphoma were diagnosed in one patient each. The average age of those that died was 83.9 years compared to 76.8 of the remaining group (p=0.033).
Conclusions Conditions that increase with age and are associated with an increased risk of falling and fracture include neurological diseases, visual loss, use of steroids and sedatives, MGUS, myeloma, pernicious anemia and vitamin B-12 and vitamin D deficiencies. These were all common in our cohort with subacute symptomatic fragility VCF. Accordingly we recommend vitamin B-12 levels and SPE in the evaluation of all patients with VCF. These findings support the emphasis on interventions to reduce the risk of falling in the elderly and to recognize and treat these age-related conditions in an attempt to mitigate the risk of VCF.
Nola JM, et al, J Rheumatol 2001;28:2289–22–93.
Dumitrescu B, et al, BMC Musculoskeletal Disorders 2008, 9:109.
Disclosure of Interest None declared