Scores on the Safe Functional Motion test predict incident vertebral compression fracture

Exercise and physical activity in individuals at risk of fracture

This is a review of evidence and practical tips on exercise for individuals with osteoporosis, including individuals with hip and vertebral fractures. Balance and functional training, with or without strength training, can prevent falls. Several types of exercise can improve outcomes that are important to patients, such as physical functioning or quality of life. Individuals with osteoporosis should prioritize balance, functional and resistance training ≥ twice weekly, where exercises, volume, intensity, and progression are aligned with the patient's goals and abilities. Patients who want to participate in other activities (e.g., walking, impact exercise, yoga, Pilates) can do them in addition to, but not instead of, balance and functional or strength training, if they can be done safely or modified. Avoid generic advice like "Don't bend or twist", which is difficult or impossible to operationalize, and may create fear and activity avoidance. Instead, be specific about the types of activities to avoid or modify, and provide tips on how to make daily activities safer, or signpost to resources from national osteoporosis societies. For example, not all bending or twisting is bad; it is activities that involve rapid, repetitive, sustained, weighted, or end range of motion twisting or flexion of the spine that may need to be modified, especially in individuals at high risk of fracture.

Hospitalization in High Fracture Risk Older Adults with Osteoporosis Using the Safe Functional Motion Test: A Longitudinal Analysis

The Safe Functional Motion Test (SFM-5) is a five item performance based clinical assessment tool quantifying habitual daily movement that may increase the risk of osteoporosis and fractures. Fractures are a major cause of hospitalization and contributor to increased health care utilization costs. A sample of 1,700 adults, aged 40 and older, from an osteoporosis specialty clinic were evaluated to determine if the initial SFM-5 score had predictive utility for determining inpatient hospitalization at 12, 24, and 36 months post fracture. When adjusted for sex, age, and prior hospitalization, logistic regression analyses indicated that the SFM-5 score significantly predicted inpatient hospitalization within 12 months, 24 months, and 36 months. For every 10 point decrease in the SFM-5 score, the 1 year risk of hospitalization increased by 24%. The SFM-5 is a tool to use when assessing habitual functional movements and hospitalization risk among high-fracture risk adults.

Functional risk for fracture by safe functional motion testing: a short version of the safe functional motion test

Background:

‘Unsafe’ movement strategies used to perform everyday activities were quantified using scores for tasks included in the Short Form Safe Functional Motion test series (SSFM). Baseline scores were independently associated with incident fractures after adjusting for factors known to effect fracture risk. The purpose of the present study is to determine whether the SSFM, a series of tests of habitual motion, is associated with incident fragility fracture at any skeletal sites.

Methods:

An osteoporosis clinic database was queried for adults with baseline SSFM scores and corresponding data for prevalent fractures, femoral neck bone mineral density (fnBMD), osteoporosis medication use, and incident fractures at 1-year and 3-year follow ups [n = 1700 (118 incident fractures) and n = 1058 (202 incident fractures), respectively]. Multiple logistic regressions, adjusted for sex, age, fnBMD, osteoporosis medication use, and any prevalent fractures at baseline, were used to determine whether baseline SSFM scores were associated with incident fragility fractures.

Results:

An Sfm-3 score was a significant independent predictor of any fracture at 1 year [adjusted odds ratio (95% CI) = 1.118 (1.025, 1.219) for each 10-point decrease in Sfm-3; p = 0.012], and 3-year follow up [adjusted odds ratio (95% CI) = 1.183 (1.098, 1.274) for each 10-point decrease in Sfm-3; p < 0.0001].

Conclusions:

Scores on the SSFM predict fracture risk such that for each 10-point drop in score the odds of fracture are increased by up to 18% independent of risk associated with age, bone mineral density, use of bone-sparing medications, and history of a fracture.

Changes in bone mineral density (BMD): a longitudinal study of osteoporosis patients in the real-world setting

In clinical practice, the frequency of patients achieving improved T-scores and the expected change in bone mineral density (BMD) according to osteoporosis drugs is unknown. We found that osteoporosis medications infrequently achieve improved femoral neck T-scores over 1.2 years. BMD increases were more often seen with IV bisphosphonates and denosumab.

PURPOSE

To determine the frequency of osteoporosis patients achieving improvement in T-scores and quantify the change in bone mineral density (BMD) over time according to osteoporosis medication use.

METHODS

The study included all patients receiving clinical care at United Osteoporosis Centers, Gainesville, GA, 1995-2015, who had at least two measures of femoral neck BMD (N = 1232). We evaluated successive pairs of BMD tests to describe the distribution of transitions between T-score categories. Generalized estimating equations were used to estimate %BMD change between successive pairs of BMD tests according to osteoporosis medication, adjusted for age, sex, height, weight, baseline BMD, previous fracture, and follow-up time.

RESULTS

Mean (±SD) age was 68 (±10) years, and 90% of patients were women. Mean baseline T-score was - 2.04 (± 0.85). In total, 1232 patients had 4918 pairs of successive BMD tests, with a mean 1.2 years (± 0.9) between assessments. Frequency of transition to an improved T-score category was 41% when prior T-score ≤ - 3.5, and 15% when prior T-score - 1.99 to - 1.50. Most individuals (69%) remained in the same T-score category. BMD increased 0.54% (95% CI 0.23-0.85%) with IV bisphosphonates and 1.23% (95% CI 0.56-1.90%) with denosumab, whereas no significant change was seen with oral bisphosphonates, teriparatide, or raloxifene.

CONCLUSIONS

Osteoporosis patients are unlikely to improve femoral neck T-scores over 1.2 years. Additional studies are needed to determine the optimal time to repeat BMD testing while receiving osteoporosis treatment and to determine whether fracture risk is reduced in patients who achieve target T-scores.

Inter-rater reliability of DartfishTM movement analysis software for measuring maximum flexion and extension at the hip and knee in older adults with osteoporosis and osteopenia

Various methods are used to measure hip and knee joint motion angles; however, their use is often limited by cost or inability to measure dynamic movements. The assessment of movement patterns is clinically useful in individuals with osteoporosis (OP) and osteopenia (OPe) through its potential to optimize fracture risk assessment. This study evaluates the inter-rater reliability of using Dartfish^TM 2-D Motion Analysis Software to measure maximum flexion and extension angles at the hip and knee in individuals with OP or OPe while performing five tasks of the Safe Functional Motion test. Twelve participants were videotaped performing the pour, footwear, newspaper, sweep, and sit-to-floor tasks. Five raters used Dartfish^TM to analyze maximum flexion and extension angles at the hip and knee, and an intra-class correlation coefficients (ICC) and SEM were calculated for each measurement. In all five tasks, ICC and SEM values ranged from 0.23 to 0.95, and 1.75 to 11.54 degrees, respectively, with maximum knee flexion angles generally having higher ICC, and lower SEM point estimates. The results indicate that Dartfish^TM measurements of maximum knee flexion angles in uniplanar tasks demonstrate a moderate to excellent degree of inter-rater reliability, while measurements at the hip joint should be used with caution. Given that the results of this study display moderate to excellent reliability, they lay the groundwork for future research aimed at determining the validity of these measurements. Such research would help to further develop the base of evidence surrounding the usefulness of Dartfish^TM Motion Analysis in fracture risk analysis among individuals with OP.

Micro CT Analysis of Spine Architecture in a Mouse Model of Scoliosis

OBJECTIVE

Mice homozygous for targeted deletion of the gene encoding fibroblast growth factor receptor 3 (FGFR3(-/-)) develop kyphoscoliosis by 2 months of age. The first objective of this study was to use high resolution X-ray to characterize curve progression in vivo and micro CT to quantify spine architecture ex vivo in FGFR3(-/-) mice. The second objective was to determine if slow release of the bone anabolic peptide parathyroid hormone related protein (PTHrP-1-34) from a pellet placed adjacent to the thoracic spine could inhibit progressive kyphoscoliosis.

MATERIALS AND METHODS

Pellets loaded with placebo or PTHrP-1-34 were implanted adjacent to the thoracic spine of 1-month-old FGFR3(-/-) mice obtained from in house breeding. X rays were captured at monthly intervals up to 4 months to quantify curve progression using the Cobb method. High resolution post-mortem scans of FGFR3(-/-) and FGFR3(+/+) spines, from C5/6 to L4/5, were captured to evaluate the 3D structure, rotation, and micro-architecture of the affected vertebrae. Un-decalcified and decalcified histology were performed on the apical and adjacent vertebrae of FGFR3(-/-) spines, and the corresponding vertebrae from FGFR3(+/+) spines.

RESULTS

The mean Cobb angle was significantly greater at all ages in FGFR3(-/-) mice compared with wild type mice and appeared to stabilize around skeletal maturity at 4 months. 3D reconstructions of the thoracic spine of 4-month-old FGFR3(-/-) mice treated with PTHrP-1-34 revealed correction of left/right asymmetry, vertebral rotation, and lateral displacement compared with mice treated with placebo. Histologic analysis of the apical vertebrae confirmed correction of the asymmetry in PTHrP-1-34 treated mice, in the absence of any change in bone volume, and a significant reduction in the wedging of intervertebral disks (IVD) seen in placebo treated mice.

CONCLUSION

Local treatment of the thoracic spine of juvenile FGFR3(-/-) mice with a bone anabolic agent inhibited progression of scoliosis, but with little impact on kyphosis. The significant improvement in IVD integrity suggests PTHrP-1-34 might also be considered as a therapeutic agent for degenerative disk disorders.

Inclinometer-based measures of standing posture in older adults with low bone mass are reliable and associated with self-reported, but not performance-based, physical function

The association between posture and physical function during daily activities in people at risk for osteoporotic fracture is not clear. We report the reliability of measuring posture using the digital inclinometer and how these measures relate to performance-based and self-reported physical function.

INTRODUCTION

This study aims to determine the reliability of a simple clinical method for assessing spine curvatures in people with low bone mass and the association between spine curvature measures and pain, physical function (mobility/activities of daily living (ADL)) and quality of life.

METHODS

One rater assessed 36 high-functioning adults, aged 52-82 years, attending an outpatient osteoporosis clinic. A digital inclinometer was used to measure lumbosacral angle (S), lumbar standing posture (L), and thoracic standing posture (T) and ADL performance was assessed using the short form of the Safe Functional Motion test (SFM-6), on two occasions approximately 8.7 days apart. Participants reported average pain intensity over the past week and completed the Timed Up and Go test (TUGT) and the mini-Osteoporosis Quality of Life questionnaire (mini-OQLQ). Acceptable reliability was determined using the intraclass correlation coefficient (ICC). Associations were determined using Pearson's correlation coefficients (r) (and Spearman's rho (r s), for non-normal data).

RESULTS

ICC (95 % CI) for S, L, and T = 0.91 (0.82, 0.95), 0.90 (0.82, 0.95), and 0.91 (0.84, 0.95), respectively, for test-retest reliability. Thoracic standing posture was associated with the ADL domain of the mini-OQLQ (r s = -0.39) and the TUGT (r = 0.42). Standing posture was not related to pain or total SFM-6 score.

CONCLUSIONS

Digital inclinometer measures provide a quick highly reliable, valid, direct assessment of kyphosis. Use of these measures in the clinical setting is expected to facilitate identification and effective management of postural impairments (e.g., trunk extensor muscle weakness, vertebral fracture) associated with osteoporosis.