INTRODUCTION
We previously reported that poor spinal sagittal alignment and malnutrition are risk factors for osteoporotic vertebral fractures (OVFs) and that appropriate intervention is important in patients with risk factors prior to OVFs. Understanding the changes that occur early after new OVFs and intervening appropriately is also important; however, few reports have examined these changes in detail. Therefore, this study aimed to investigate the changes in clinical symptoms and body composition before and after new OVFs in older female patients with primary osteoporosis.
METHODS
In total, 271 female patients with osteoporosis, aged ≥60 (mean: 74.3) years, who visited the osteoporosis outpatient clinic at our hospital and were available for investigation at 1 year after the visit were included in the study. Bone mineral density of the lumbar spine, femoral neck, and proximal femur, grip strength (better grip strength between left or right was used), muscle mass (measured using the bioimpedance method), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed at the time of consultation and 1 year after consultation, and the amount and rate of change in each item were investigated. The group with new OVFs confirmed by whole spine X-ray at 1 year after the visit was defined as OVF+ group and was compared with OVF- group for each item.
RESULTS
New OVFs occurred in 31 (11.4%) patients during 1 year. When comparing between OVF+ and OVF- group, bone mineral density at the time of consultation did not significantly differ; however, 1 year after the examination, OVF+ group showed a significantly lower rate of change in the bone mineral density of the proximal femur, compared with OVF- group. No significant intergroup differences were found in grip strength and limb muscle mass at the time of consultation; however, the changes of each parameter during 1 year was significantly lower in the OVF+ group versus OVF- group. In addition, OVF+ group had significantly lower several clinical scores at first visit (before OVF) including pain-related disorder and social life dysfunction domains of the JOABPEQ (p<0.05).
DISCUSSION
The group with new OVFs had a poor lower back pain score before the fracture, and despite osteoporosis treatment after the fracture, showed a poor increase in proximal femur bone mineral density along with significantly decreased grip strength and limb muscle mass. These results reflect poor low back pain before the fracture and reduced physical activity owing to further pain after the fracture. Based on these findings, we emphasize the importance of active pain treatment before the fracture and rehabilitation after the fracture, aiming to maintain motor function to the greatest extent possible.