1
|
Takahashi K, Wakabayashi H, Maeda K, Nagai T, Momosaki R. Impact of body mass index on outcomes of inpatients with vertebral compression fractures in Japan: A retrospective cohort study. Geriatr Gerontol Int 2023; 23:788-794. [PMID: 37735145 DOI: 10.1111/ggi.14676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
AIM The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures. METHODS A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2 ), normal weight (18.5-22.9 kg/m2 ), overweight (23.0-27.4 kg/m2 ) and obese (≥27.5 kg/m2 ) according to the World Health Organization criteria for the Asia-Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge. RESULTS Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30-day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain -3.63 points (95% confidence interval -4.58 to -2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001). CONCLUSIONS In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788-794.
Collapse
Affiliation(s)
- Kohei Takahashi
- Tamura Surgical Hospital Department of Rehabilitation, Tamura Surgical Hospital, Kawasaki-shi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Morioka, Japan
| | - Takako Nagai
- Department of Rehabilitation Medicine, Nihon University Hospital, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
2
|
Wen Z, Mo X, Zhao S, Qi Z, Fu D, Wen S, Cheung WH, Chen B. Study on Risk Factors of Primary Non-traumatic OVCF in Chinese Elderly and a Novel Prediction Model. Orthop Surg 2022; 14:2925-2938. [PMID: 36168985 PMCID: PMC9627056 DOI: 10.1111/os.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Prevention of fragility fractures is one of the public health priorities worldwide, whilst the incidence of osteoporotic vertebral compression fractures (OVCF) continues to rise and lacks the corresponding accurate prediction model. This study aimed to screen potential causes and risk factors for primary non‐traumatic osteoporotic vertebral compression fractures (NTOVCF) in the elderly by characterizing a patient population with NTOVCF and comparing it with a population of osteoporotic patients. Methods Between January 2013 and January 2022, 208 elderly patients with unequivocal evidence of bone fragility manifested as painful NTOVCF were enrolled, and compared with 220 patients with osteoporosis and no fractures. The demographic data, bone turnover markers, blood routine, serum biochemical values, and radiological findings were investigated. Differences between the fracture and non‐fracture groups were analyzed, and variables significant in univariate analysis and correlation analysis were included in the logistic analysis to build the risk prediction model for osteoporotic vertebral fractures. Univariate analysis using student's t‐tests for continuous variables or a chi‐squared test for categorical variables was conducted to identify risk factors. Results No significant differences were revealed regarding age, gender, BMI, smoking, alcohol consumption, blood glucose, propeptide of type I procollagen (P1NP), and N‐terminal middle segment osteocalcin (N‐MID) (P > 0.05). Parathyroid Hormone (PTH), 25(OH)D, serum albumin (ALB), hemoglobin (HB), bone mineral density (BMD), and cross‐sectional area (CSA) of the paraspinal muscle in the fracture group were significantly lower than those in the control group; however, b‐C‐terminal telopeptide of type I collagen (β‐CTX), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C), non‐prostatic acid phosphatase (NACP), and fatty degeneration ratio (FDR) were significantly higher than those in the control group (P < 0.05). Logistic regression analysis showed that ALB, HB, CSA, and BMD were negatively correlated with NTOVCF, while β‐CTX, HDL‐C, NACP, and FDR were positively correlated with NTOVCF. Conclusion Decreased physical activity, anemia, hypoproteinemia, imbalances in bone metabolism, abnormal lipid metabolism, and degenerative and decreased muscle mass, were all risk factors for OVCF in the elderly, spontaneous fractures may be the consequence of cumulative declines in multiple physiological systems over the lifespan. Based on this risk model, timely detection of patients with high OVCF risk and implementation of targeted preventive measures is expected to improve the effect of fracture prevention.
Collapse
Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhichao Qi
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Orthopaedics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Dan Fu
- Department of Orthopaedics, Kiang Wu Hospital, Macau, China
| | - Shifeng Wen
- Department of Spine Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
3
|
Vertebral Related Diseases in Healthcare: The Role of Pain Management and Rehabilitation. Healthcare (Basel) 2022; 10:healthcare10061109. [PMID: 35742160 PMCID: PMC9223211 DOI: 10.3390/healthcare10061109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
The increase in the life expectancy of the general population implied for vertebral diseases an impacting role for the medical condition of the person, not only in the clinical context, but also from a social and economic point of view, due to the underestimation of primary prevention and complex secondary prevention rehabilitation frameworks [...]
Collapse
|
4
|
Sueyoshi Y, Ogawa T, Koike M, Hamazato M, Hokama R, Tokashiki S, Nakayama Y. Improved activities of daily living in elderly patients with increased skeletal muscle mass during vertebral compression fracture rehabilitation. Eur Geriatr Med 2022; 13:1221-1228. [PMID: 35698005 DOI: 10.1007/s41999-022-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE We hypothesized that elderly patients with greater skeletal muscle mass have better activities of daily living (ADLs) than those with less skeletal muscle mass. The aim of this study was to evaluate the relationship between ADL improvement and changes in skeletal muscle mass among older patients ≥ 80 years of age who were undergoing rehabilitation for vertebral compression fracture (VCF). METHODS This case-control study was conducted at a rehabilitation hospital. The participants were 149 patients aged ≥ 80 years undergoing VCF rehabilitation. Patients were divided into two groups based on changes in their skeletal muscle mass index (SMI) during the hospitalization period: one group with increased SMI and the other without increased SMI. Between-group and multivariate analyses were performed to evaluate the factors associated with SMI increase. RESULTS The functional independence measure (FIM) gain was significantly higher in the group with SMI increase (36.0 [27.0-52.5], p = 0.016) than in the group without SMI increase (29.0 [19.0-41.0]). SMI gain was significantly associated with motor FIM gain (coefficient, 4.857; 95% confidence interval, 1.311-8.403; p = 0.008). Motor FIM and MMSE on admission, the necessity of assistance in ADL before the injury, and Charlson Comorbidity Index, were also significantly associated with motor FIM gain. CONCLUSIONS This study indicated that rehabilitation to gain skeletal muscle was effective in improving ADLs in elderly patients with VCF. We might encourage older patients with VCFs to undertake rehabilitation for the purpose of building skeletal muscle and improving their ADLs, and to not refrain from such rehabilitation due to old age and fractures.
Collapse
Affiliation(s)
- Yuki Sueyoshi
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan.
| | - Masaki Koike
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Mayumi Hamazato
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Ryota Hokama
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Satoko Tokashiki
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| | - Yuki Nakayama
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan
| |
Collapse
|
5
|
Ogawa T, Onaga A, Oshiro N, Oshiro A, Kitagawa Y, Taira Y, Nakahodo S, Oshiro K. Older patients with less skeletal muscle mass gain more skeletal muscle in rehabilitation wards after fractures. Eur Geriatr Med 2021; 13:615-622. [PMID: 34850373 DOI: 10.1007/s41999-021-00596-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We hypothesized that old patients could increase skeletal muscle mass after fractures by exercise rehabilitation, even if they have a low initial muscle mass. AIM This study aimed to evaluate the relationship between skeletal muscle mass and skeletal muscle changes in older patients after fractures. METHODS This case-control study took place in rehabilitation wards and included 807 patients aged ≥ 65 years with fractures. Patients were divided into two groups based on the skeletal muscle index (SMI) on admission by the sarcopenia cut-off points: low SMI group included patients with SMI < 7.0 for men and < 5.7 for women and high SMI group included patients with SMI ≥ 7.0 for men and ≥ 5.7 for women. Analysis of comparison between the two groups and multivariate logistic regression analyses were performed. RESULTS The SMI gain was significantly higher in the low SMI group (0.20) than in the high SMI group (0.00, p < 0.001). There were also the differences in age, BMI, mini nutritional assessment short form, Charlson comorbidity index, length of hospital stay, and protein intake. The SMI on admission was significantly associated with increased SMI after rehabilitation (odds ratio 0.569, 95% confidence interval 0.455‒0.710). Length from onset to transfer to the hospital, hospital stay, and period of exercise therapy were also significantly associated with increased SMI. CONCLUSIONS We found that older patients with low SMI after fracture gained more skeletal muscle mass than those with high SMI following exercise rehabilitation. In addition, SMI on admission was one of the factors independently associated with increased SMI.
Collapse
Affiliation(s)
- Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan.
| | - Anri Onaga
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - Nami Oshiro
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - Ayumi Oshiro
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - You Kitagawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - Yasuko Taira
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - Shiori Nakahodo
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| | - Kurumi Oshiro
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa city, Okinawa, 904-2151, Japan
| |
Collapse
|