Abstract
PURPOSE: To
determine if vertebral compression fractures in elderly women were associated
with impairments in physical, functional, and psychosocial performance. SUBJECTS
AND METHODS: Ten white women with confirmed vertebral compression fractures
were age- and race-matched with 10 control subjects without fractures in a
case-control design. All subjects invited to participate in this study were
patients of the Geriatrics Division of the Department of Medicine at Duke
University Medical Center. All study participants lived either in the community
or in the independent-living sections of local retirement communities in and
around Durham, NC. Subjects with fractures (mean age = 81.9 years, SD = 5.9
years) had two or more vertebral compression fractures in their medical
records, whereas control subjects (mean age = 79.6 years, SD = 6.5 years) had
no history of vertebral fractures. Spinal radiographs of all women confirmed
group assignment. Physical, functional, and psychosocial performances were
evaluated. Physical performance was assessed by measurements of maximal trunk
extension torque and thoracic and lumbar spinal motion in the sagittal plane,
functional reach, mobility skills, 10-ft timed walk, and 6-minute walk test.
Thoracic and lumbar spinal configurations were also determined. Functional
performance was assessed using the Functional Status Index. Psychosocial performance
was assessed with the following scales: Hopkins Symptom Checklist 90 Revised,
Rosenberg Self-Esteem Scale, West Haven-Yale Pain Inventory, Beck Depression
Inventory, and single-item health-belief questions. RESULTS: Control
subjects were not significantly different from patients with fractures in age,
weight, number of current illnesses, number of prescribed medications, number
of pain medications, ratings of lumbar spine degenerative disc disease, or
lumbar spine facet joint arthritis. Activity levels and exercise participation
were similar in both groups. Control subjects had no vertebral fractures,
whereas fracture subjects had 4.2 +/- 2.6 fractures (range: 2 to 10). Thoracic
kyphosis was increased and lumbar lordosis was reduced in fracture subjects.
Fracture subjects had reduced maximal trunk extension torque, thoracic and
lumbar spine sagittal plane motion, functional reach, mobility skills, and
6-minute walk test. The Functional Status Index showed reduced levels of
functional performance in fracture subjects compared with controls with
increased levels of assistance, pain with activity, and difficulty in
activities. Psychosocial performance was limited in fracture subjects with
increased psychiatric symptoms, increased pain, and greater perception of
problems caused by health. CONCLUSION: Vertebral compression fractures
are associated with significant performance impairments in physical,
functional, and psychosocial domains in older women.
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