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Risk factors for cognitive decline following osteoporotic vertebral fractures: A multicenter cohort study
Authors:Shinji Takahashi  Masatoshi Hoshino  Tadao Tsujio  Hidetomi Terai  Akinobu Suzuki  Takashi Namikawa  Minori Kato  Akira Matsumura  Kazushi Takayama  Hiroaki Nakamura
Affiliation:1. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;2. Department of Orthopaedic Surgery, Shiraniwa Hospital, 6-10-1, Shiraniwadai, Ikoma City, Nara, Japan;3. Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-ku, Osaka, Japan;4. Department of Orthopaedic Surgery, Seikeikai Hospital, 6-2-11, Koryonakamachi, Sakai-ku, Sakai City, Osaka, Japan
Abstract:

Background

Osteoporotic vertebral fractures (OVFs) are the most common cause of intractable back pain and reduced activities of daily living (ADL), which may affect cognitive function. However, no previous studies have reported a change in cognitive function after OVFs. The purpose was to reveal cognitive function changes after OVFs and investigate the risk factors for cognitive decline.

Methods

Consecutive patients with symptomatic OVFs were enrolled in a prospective multicenter cohort study. The inclusion criteria were age >65 years, diagnosis of acute or subacute OVF, and back pain onset within 2 months prior to presentation. Cognitive function was assessed with the mini-mental state examination. Medical history, radiological findings, and ADL were investigated as risk factors for cognitive decline.

Results

We recruited a sample of 339 patients (58 men and 281 women) who met the inclusion criteria. Patients underwent examinations and completed questionnaires at both the time of enrollment and at 6-month follow-up. At 6-month follow-up, cognitive decline was observed in 26 (7.7%) patients. Medical history, including comorbidities and sports activities, did not affect odds ratios (ORs). However, elevated ORs were associated with delayed union (OR: 4.67, 95% Confidence interval: 1.22–17.87). In addition, significantly increased ORs were associated with reduced ADL at 6-month follow-up.

Conclusions

The current results revealed the incidence of cognitive decline after the onset of OVF. Delayed union and reduced ADL at 6-month follow-up were associated with cognitive decline. Patients with cognitive decline experienced significantly reduced quality of life. These results highlight the importance of preventing cognitive impairment in patients with symptomatic OVF. Physical treatment or early surgical treatment may provide appropriate options, particularly for patients with suspected delayed union.
Keywords:Corresponding author. Fax: +81 6 6646 6260.
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