Takahashi Shinji, Hoshino Masatoshi, Tsujio Tadao, Terai Hidetomi, Suzuki Akinobu, Namikawa Takashi, Kato Minori, Matsumura Akira, Takayama Kazushi, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
J Orthop Sci. 2017 Sep;22(5):834-839. doi: 10.1016/j.jos.2017.04.008. Epub 2017 May 10.
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.
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.
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.
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.
骨质疏松性椎体骨折（OVF）是顽固性背痛和日常生活活动（ADL）能力下降的最常见原因，这可能会影响认知功能。然而，此前尚无研究报道OVF后认知功能的变化。本研究旨在揭示OVF后认知功能的变化，并调查认知功能下降的危险因素。
连续纳入有症状的OVF患者进行前瞻性多中心队列研究。纳入标准为年龄>65岁、急性或亚急性OVF诊断以及就诊前2个月内出现背痛。采用简易精神状态检查表评估认知功能。调查病史、影像学检查结果和ADL作为认知功能下降的危险因素。
我们招募了339例符合纳入标准的患者（58例男性和281例女性）。患者在入组时和随访6个月时均接受了检查并完成了问卷调查。在随访6个月时，26例（7.7%）患者出现认知功能下降。包括合并症和体育活动在内的病史不影响比值比（OR）。然而，延迟愈合与较高的OR相关（OR：4.67，95%置信区间：1.22-17.87）。此外，随访6个月时ADL降低与OR显著升高相关。
目前的结果揭示了OVF发病后认知功能下降的发生率。延迟愈合和随访6个月时ADL降低与认知功能下降相关。认知功能下降的患者生活质量显著降低。这些结果凸显了预防有症状OVF患者认知障碍的重要性。物理治疗或早期手术治疗可能提供合适的选择，特别是对于疑似延迟愈合的患者。
