Vertebral fractures, function and cognitive status in osteoporotic hip fractured women: The FOCUS study

Introduction: Osteoporosis is characterized by low bone mass and microarchitectural modifications of bone tissue, with a consequent increase in fragility fractures. Vertebral fractures (VF) are the most prevalent osteoporotic fractures and osteoporotic hip fractures are the most serious complication of osteoporosis. The objectives of the present study were to determine the prevalence of VF in osteoporotic hip fractured women and to evaluate their association with pre-existing factors such as activities of daily living, quality of walking, numbers of falls, cognitive aspects and comorbidities. Material and methods: Twenty-five departments of Orthopaedics, Rehabilitation and Geriatrics participated in the present cross-sectional observational study. Data for 916 osteoporotic hip fractured women were collected, including spine X-ray morphometry, pre-fracture Functional Ambulation Category (FAC), RANKIN scale, Short portable Mental Status Questionnaire (SPMSQ), Instrumental Activities of Daily Living (IADL), ADL, Cumulative Illness Rating Scale (CIRS), history of falls in the last 12 months and serum 25(OH)D measure. Results: VFs were present in 54% of hip fractured patients. The VF group showed worse scores regarding the pre-hip fracture values for RANKIN, CIRS, SPMSQ, IADL than the group with no VF. Multivariable logistic regression analysis showed a significant association between the presence of VF and family history of fragility fractures, patients' history of fractures, height, previous osteoporosis treatment and RANKIN pre-fracture score. Subgroup (n = 417) analysis showed a strong association between 25(OH)D levels and CIRS with the presence of VF. Conclusions: Previous VF are a common issue in osteoporotic hip fractured patients and negatively influence outcome measures in these patients.