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Exploring the association between number, severity, location of fracture, and occiput-to-wall distance

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Abstract

Summary

This study of women with a suspected vertebral fracture determined the association between vertebral fracture characteristics and posture. The number of fractures was associated with posture. Severity of fracture was associated with posture when adjusting for pain. Fracture characteristics explain some variability in posture in women with a suspected vertebral fracture.

Purpose

Osteoporotic vertebral fractures are associated with increased morbidity and mortality. An accumulation of vertebral fractures may lead to forward head posture, which has been independently associated with mortality. It is unclear how fracture characteristics, including the number, severity, and location of fracture, contribute to occiput-to-wall distance (OWD).

Methods

This was a cross-sectional secondary data analysis using baseline data from a randomized controlled trial, in community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. Occiput-to-wall distance (OWD) was used to assess forward head posture. Pain during movement (0–10 scale) and age were considered as confounding variables. Multivariable regression models were used to evaluate relationships between fracture variables and OWD.

Results

Participants (n = 158) were of mean age 75.9 (SD 6.5) years with a mean (SD) BMI = 26.7 (5.3) kg/m2, OWD = 5.7 (4.6) cm, and number of fractures = 2.4 (2.4). In unadjusted analyses, the number of fractures (B = 0.82, 95% CI = 0.04, 1.59) was associated with OWD. When adjusting for pain, severity of fractures (B = 1.08, 95% CI = 0.001, 2.15) was independently associated with OWD. Location was not associated with OWD in any of the models.

Conclusions

The number of fractures was significantly associated with OWD in the unadjusted model, explaining more of the variability in OWD than other fracture characteristics. Severity of fracture was associated with OWD in the adjusted model. However, pain may confound the relationship between OWD and fracture characteristics.

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References

  1. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(2):S3–S7

    Article  Google Scholar 

  2. Jackson S, Tenenhouse A, Robertson L, CaMos Study Group (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11(8):680–687

    Article  CAS  Google Scholar 

  3. Gallacher S, Gallagher A, McQuillian C, Mitchell P, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18(2):185–192

    Article  CAS  Google Scholar 

  4. Cauley JA, Hochberg MC, Lui L, Palermo L, Ensrud KE, Hillier TA et al (2007) Long-term risk of incident vertebral fractures. JAMA. 298(23):2761–2767

    Article  CAS  Google Scholar 

  5. Melton Iii L, Atkinson E, Cooper C, O’Fallon W, Riggs B (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221

    Article  Google Scholar 

  6. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739

    Article  CAS  Google Scholar 

  7. Cooper C, O’neill T, Silman A (1993) European Vertebral Osteoporosis Study Group. The epidemiology of vertebral fractures. Bone. 14:89–97

    Article  Google Scholar 

  8. Kado DM, Huang M, Karlamangla AS, Barrett-Connor E, Greendale GA (2004) Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study. J Am Geriatr Soc 52(10):1662–1667

    Article  Google Scholar 

  9. Ettinger B, Black DM, Palermo L, Nevitt MC, Melnikoff S, Cummings SR (1994) Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures. Osteoporos Int 4(1):55–60

    Article  CAS  Google Scholar 

  10. Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR (2005) Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength. Osteoporos Int 16(8):1004–1010

    Article  Google Scholar 

  11. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. 282(7):637–645

    Article  CAS  Google Scholar 

  12. Katzman W, Vittinghoff E, Lin F, Schafer A, Long R, Wong S et al (2017) Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial. Osteoporos Int 28(10):2831–2841

    Article  CAS  Google Scholar 

  13. Siminoski K, Warshawski RS, Jen H (2011) Lee K-. The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures. J Musculoskelet Neuronal Interact 11(3):249–256

    CAS  PubMed  Google Scholar 

  14. Kado DM, Miller-Martinez D, Lui L, Cawthon P, Katzman WB, Hillier TA et al (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: The Study of Osteoporotic Fractures (SOF). J Bone Miner Res 29(10):2210–2216

    Article  Google Scholar 

  15. Ribom EL, Kindmark A, Ljunggren Ö (2014) Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis. Physiother Theory Pract 31(3):182–185

    Article  Google Scholar 

  16. Cortet B, Roches E, Logier R, Houvenagel E, Gaydier-Souquières G, Puisieux F, Delcambre B (2002) Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. Joint Bone Spine 69(2):201–208

    Article  Google Scholar 

  17. Delmas P, Genant H, Crans G, Stock J, Wong M, Siris E et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 33(4):522–532

    Article  CAS  Google Scholar 

  18. Nevitt M, Ross P, Palermo L, Musliner T, Genant H, Thompson D et al (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. Bone. 25(5):613–619

    Article  CAS  Google Scholar 

  19. Evstigneeva L, Lesnyak O, Bultink I, Lems W, Kozhemyakina E, Negodaeva E et al (2016) Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial. Osteoporos Int 27(8):2515–2524

    Article  CAS  Google Scholar 

  20. Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney RR, Braun EA, Cheung AM, Fraser LA, Gibbs JC, Hill KD, Hodsman AB, Kendler DL, Mittmann N, Prasad S, Scherer SC, Wark JD, Papaioannou A (2014) Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther 94(9):1337–1352

    Article  Google Scholar 

  21. Balzini L, Vannucchi L, Benvenuti F, Benucci M, Monni M, Cappozzo A, Stanhope SJ (2003) Clinical characteristics of flexed posture in elderly women. J Am Geriatr Soc 51(10):1419–1426

    Article  Google Scholar 

  22. Sugalya A (2012) Concurrent validity of occiput-wall distance to measure kyphosis in communities. J Clin Trials

  23. Van Der Jagt-Willems HC, De Groot MH, Van Campen JPCM, Lamoth CJC, Lems WF.(2015) Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: A prospective cohort study. BMC Geriatrics. 15(1)

  24. Shipe NK, Billek-Sawhney B, Canter TA, Meals DJ, Nestler JM, Stumpff JL (2013) The intra-and inter-rater reliability of the tragus wall distance (TWD) measurement in non-pathological participants ages 18–34. Physiotherapy Theory and Practice 29(4):328–334

    Article  Google Scholar 

  25. Genant HK, Jergas M, Palermo L, Nevitt M, San Valentin R, Black D et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11(7):984–996

    Article  CAS  Google Scholar 

  26. Johansson H, Odén A, McCloskey E, Kanis J (2014) Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures. Osteoporos Int 25(1):235–241

    Article  CAS  Google Scholar 

  27. Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci 68(10):1236–1242

    Article  Google Scholar 

  28. Antonelli-Incalzi R, Pedone C, Cesari M, Di Iorio A, Bandinelli S, Ferrucci L (2007) Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study. Aging Clin Exp Res 19(3):207–212

    Article  Google Scholar 

  29. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA (2002) The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int 13(11):868–873

    Article  CAS  Google Scholar 

  30. Sun G, Shook TL, Kay GL (1996) Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 49(8):907–916

    Article  CAS  Google Scholar 

  31. Katzman W, Vittinghoff E, Kado D, Lane N, Ensrud K, Shipp K (2016) Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int:1–5

  32. De Groot MH, van der Jagt-Willems HC, van Campen JPCM, Lems WF, Beijnen JH, Lamoth CJC (2014) A flexed posture in elderly patients is associated with impairments in postural control during walking. Gait Posture 39(2):767–772

    Article  Google Scholar 

  33. Greig AM, Bennell KL, Briggs AM, Wark JD, Hodges PW (2007) Balance impairment is related to vertebral fracture rather than thoracic kyphosis in individuals with osteoporosis. Osteoporos Int 18(4):543–551

    Article  CAS  Google Scholar 

  34. Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128(10):793–800

    Article  CAS  Google Scholar 

  35. Abe K, Tamaki J, Kadowaki E, Sato Y, Morita A, Komatsu M, Takeuchi S, Kajita E, Iki M, Fukui Osteoporosis Cohort (2008) Use of anthropometric indicators in screening for undiagnosed vertebral fractures: a cross-sectional analysis of the Fukui Osteoporosis Cohort (FOC) study. BMC Musculoskelet Disord 9(1):157

    Article  Google Scholar 

  36. Leidig-Bruckner G, Minne H, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T et al (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 12(4):663–675

    Article  CAS  Google Scholar 

  37. Jones KR, Vojir CP, Hutt E, Fink R (2007) Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev 44(2):305–314

    Article  Google Scholar 

  38. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 61(2):277–284

    Article  CAS  Google Scholar 

  39. Bergland A, Thorsen H, Kåresen R (2011) Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int 22(6):1863–1871

    Article  CAS  Google Scholar 

  40. Singla D, Veqar Z, Hussain ME (2017 Jun) Photogrammetric assessment of upper body posture using postural angles: a literature review. J Chiropr Med 16(2):131–138

    Article  Google Scholar 

  41. Geusens P, Vosse D, van der Linden S (2007 Jul) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19(4):335–339

    Article  Google Scholar 

  42. White SC, Atchison KA, Gornbein JA, Nattiv A, Paganini-Hill A (2006) Risk factors for fractures in older men and women: The Leisure World Cohort Study. Gend Med 3(2):110–123

    Article  Google Scholar 

  43. Roux C, Priol G, Fechtenbaum J, Cortet B, Liu-Léage S, Audran M (2007) A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain. Ann Rheum Dis 66(1):81–85

    Article  CAS  Google Scholar 

Download references

Funding

The research was funded by a CIHR Operating grant (MOP: 123445). Dr. Giangregorio received funding from an Ontario Ministry of Health Research and Innovation-Early Researcher Award, CIHR New Investigator Award, the Canadian Foundation for Innovation and the Bloomberg Manulife Prize. Dr. Ashe received support from the Canada Research Chairs program. Dr. Cheung is supported by a Tier 1 CRC in Musculoskeletal and Postmenopausal Health as well as the Lillian Love Chair in Women’s Health at the University of Toronto and University Health Network. Dr. Gibbs received funding from a CIHR Fellowship Award.

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Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

    Christina Ziebart, Jenna C. Gibbs, Caitlin McArthur & Lora M. Giangregorio

  2. University of Western Ontario, London, Canada

    Christina Ziebart

  3. McMaster University, Hamilton, Canada

    Jonathan D. Adachi, Aliya A. Khan, Caitlin McArthur, Alexandra Papaioannou, Sadhana Prasad & Lehana Thabane

  4. St Joseph’s Healthcare—Hamilton, Hamilton, Canada

    Jonathan D. Adachi & Lehana Thabane

  5. University of British Columbia, Vancouver, Canada

    Maureen C. Ashe & David L. Kendler

  6. Centre for Hip Health and Mobility, Vancouver, Canada

    Maureen C. Ashe

  7. Department of Medicine, University of Toronto, Toronto, Canada

    Robert R. Bleakney, Angela M. Cheung & Sandra Kim

  8. University Health Network, Toronto, Canada

    Angela M. Cheung & Lora M. Giangregorio

  9. School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia

    Keith D. Hill

  10. Women’s College Hospital, Toronto, Canada

    Sandra Kim

  11. Geriatric Education and Research in Aging Sciences Centre, Hamilton, Canada

    Caitlin McArthur & Alexandra Papaioannou

  12. Sunnybrook Health Sciences Centre, Toronto, Canada

    Nicole Mittmann

  13. Broadmeadows Health Service, Broadmeadows, Australia

    Samuel C. Scherer

  14. University of Melbourne, Melbourne, Australia

    Samuel C. Scherer & John D. Wark

  15. Royal Melbourne Hospital, Parkville, Australia

    John D. Wark

  16. Schlegel-UW Research Institute for Aging, Waterloo, Canada

    Lora M. Giangregorio

Authors
  1. Christina Ziebart
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  2. Jonathan D. Adachi
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Contributions

Christina M.D. Ziebart, Jonathan D. Adachi, Maureen C. Ashe, Robert R. Bleakney Angela M. Cheung, Jenna C. Gibbs, Keith D. Hill, David L. Kendler, Aliya A. Khan, Sandra Kim, Caitlin McArthur, Nicole Mittmann, Alexandra Papaioannou, Sadhana Prasad, Samuel C. Scherer, Lehana Thabane, John D. Wark, and Lora M. Giangregorio have all provided meaningful contributions to this manuscript.

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Correspondence to Lora M. Giangregorio.

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Ziebart, C., Adachi, J.D., Ashe, M.C. et al. Exploring the association between number, severity, location of fracture, and occiput-to-wall distance. Arch Osteoporos 14, 27 (2019). https://doi.org/10.1007/s11657-019-0582-5

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