Timed loaded standing: a measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis.

Chronic back tiredness or fatigue is a common complaint of people who have a history of osteoporotic vertebral fracture. Trunk muscle endurance has not been studied in people with vertebral osteoporosis, partly due to the lack of assessment tools. We developed a measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis, timed loaded standing (TLS). TLS measures the time a person can stand while holding a two-pound dumbbell in each hand with the arms at 90 degrees of shoulder flexion and the elbows extended. Intraclass correlation coefficients (ICCs) for same day inter-trial and six to ten day test-retest reliability were 0.89 (lower bound 95% confidence interval [LB 95% CI] 0.79) and 0.84 (LB 95% CI 0.68), respectively, in a sample of 21 older women with no known osteoporosis. In 127 women with vertebral fractures, the ICC for same day inter-trial reliability was 0.81 (LB 95% CI 0.75). In a sub-sample of 30 of these women with vertebral fractures, the six to ten day test-retest reliability was 0.85 (LB 95% CI 0.75). Moderately strong and statistically significant (p < or = 0.05) correlations were found between TLS and sixteen of eighteen measures of physical impairment and function. Functional reach distance, gait velocity, MOS-36 Physical Function Subscale, shoulder flexion strength, and six minute walk distance were most strongly associated with TLS time. Women with vertebral fractures who endorsed having back tiredness when standing and working with the arms in front of the body, sitting to rest because of back tiredness or pain, and planning rest periods because of back tiredness or pain had significantly lower TLS times. TLS is a simple, safe physical performance measure of combined trunk and arm endurance that demonstrates acceptable reliability (inter-trial and test- retest) and concurrent validity.

Spinal deformity and mobility self-confidence among women with osteoporosis and vertebral fractures.

This study evaluated the direct and indirect effects of spinal deformity on confidence in mobility among 185 older women with osteoporosis and vertebral fractures. We administered multidimensional tests of physical and psychosocial impairment and function to female residents of continuing care retirement communities, and used path analytic regression methods to delineate relationships between spinal deformity, pain, function and mobility self-confidence. No direct effect of spinal deformity on confidence in mobility was observed. However, important indirect paths mediated by functional limitations were confirmed. A pattern of indirect effects was observed for a broad array of impairment-level constructs. These results support current models of the disablement process that propose functional limitations as the major pathway to disability. However, they also suggest that the impact of impairment-level constructs might be overlooked unless we evaluate indirect, as well as direct effects, on disability.

Factors associated with self-rated health in patients with Paget's disease of bone.

Multiple studies show that poor self-rated health (SRH) increases the risk of mortality up to 5-fold when compared to excellent SRH. This powerful association remains even with objective health status and risk factors controlled. However, few studies have examined the determinants of SRH, especially as they relate to specific chronic diseases. Here we identify personal characteristics and disease-related attributes that are strongly associated with SRH in a sample of patients with Paget's disease of bone to determine whether any factors can be modified. Two thousand people randomly selected from the Paget Foundation mailing list received a survey asking for information on demographics, general health and functioning, and the impact of Paget's disease. Nine hundred and fifty-eight PD patients returned the completed survey and answered the question, "How would you rate your overall health?" Answers ranged from excellent (1) to poor (5). Ordinary least squares regression was used, with SRH as the dependent variable, to identify those variables significantly associated with SRH. The overall regression model was significant (p = 0.0001; R2 = 0.44). Age (p = 0. 005), satisfaction with family help (p = 0.0001), number of comorbid conditions (p = 0.0001), functional limitations (p = 0.0003), disease impact (p = 0.0002), health compared to 5 years ago (p = 0. 0001), and depressive symptoms (p = 0.012) were significant predictors. Of these, satisfaction with family help, functional limitations, disease impact, and depressive symptoms are potentially modifiable with appropriate interventions. Future longitudinal studies should examine the effectiveness of such interventions in improving SRH.

Kinematic characterization of standing reach: comparison of younger vs. older subjects.

OBJECTIVE: To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults. DESIGN: Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis. BACKGROUND: Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations. METHODS: Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects. RESULTS: Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects. CONCLUSION: This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.

Managing patients with complications of osteoporosis.

This article reviews the impact of osteoporosis on quality of life. It defines specific impairments and suggests how best to minimize the impact of osteoporosis on patients' daily lives. Specific issues such as a spinal deformity, limitations on activities of daily living, pain, functionality, social impairment, self esteem, and depression also are addressed. Finally, a multidisciplinary team approach to osteoporosis is advocated.

Peyronie's disease is associated with Paget's disease of bone.

Peyronie's disease is an idiopathic disorder in which an inflammatory fibrosis occurs in the tunica albuginea of the corpora cavernosa which causes the erect penis to become deformed. Peyronie's disease has a prevalence of 1% in men over age 50 years. Paget's disease of bone is a chronic skeletal disease with areas of increased bone turnover leading to pain, deformity, and in some cases arthritis. Because of a high rate of Peyronie's disease in subjects in a Paget's disease industry-sponsored drug trial, we asked whether there was an association between Peyronie's disease and Paget's disease of bone. We evaluated 61 men with Paget's disease attending our clinic for metabolic bone disease in a tertiary referral hospital, reviewed hospital records of all men discharged from our three hospitals with the diagnosis of Peyronie's disease, and mailed a validated questionnaire about shape of the erect penis to 1500 male members of the Paget Foundation. In the clinic population of men with Paget's disease of bone, 51 of 61 (83.6%) reported having normal erections; 10 patients (16.4%) were impotent. Sixteen of the 51 men (31.4%) had developed a bend or deformity in their erect penis which was confirmed by a urologist's examination to be Peyronie's disease. When the men with Paget's disease with and without Peyronie's disease were compared, there was no difference in their ages, years with Paget's disease, or serum alkaline phosphatase level. Upon medical record review, 1 patient of 262 (0.4%) with Peyronie's disease was found to have Paget's disease of bone. The men with Paget's disease returned their questionnaires for a response rate of 44.8% and reported Peyronie's disease with a prevalence of 14.5%. We suggest that Peyronie's disease is associated with Paget's disease of bone. Furthermore, we suggest that Peyronie's disease may be a previously unrecognized complication of Paget's disease of bone.

Paget's disease of bone and quality of life.

Little is known about how Paget's disease of bone affects quality of life. To better understand the relative impact of factors on quality of life, we mailed a brief survey to 2000 people randomly selected from the Paget's Foundation mailing list. The sample was geographically stratified to examine the effects of specialist availability. Nine hundred and fifty-eight persons responded to the questionnaire (53% response rate after adjustment for death, incorrect addresses, and nondeliverable mailings). The sample had equal proportions of males and females, with a mean age of 74 years (SD = 9.0). Most (97%) were white, with high levels of education (mean 13 years; SD 3.7) and income (60% earned more than $20,000 annually). They reported pagetic bone in the skull (34%), spine (35%), pelvis (49%), and leg (48%). The most frequently mentioned complications were hearing loss (37%) and bowed limbs (31%). Comorbidity included arthritis (64%), hypertension (32%), and heart problems (28%). Nearly half (47%) reported feelings of depression, and 42% said that their health was fair or poor. Only 21% reported that quality of life was very good or excellent. In multiple partial F-test regression analyses, variables were divided into four domains (social, psychological, care, and biomedical). The psychological domain explained 19% of the variance beyond that explained by all other variables; the social domain explained 3%, the biomedical domain explained 3% and the care domain explained 1%. The importance of the psychological aspects of Paget's disease suggests that treatment protocols should include psychological intervention to improve quality of life.

Relationships between mobility of axial structures and physical performance.

BACKGROUND AND PURPOSE: Many day-to-day activities require bending and twisting motions of the spine (axial mobility). Because little is known about the relationship between axial mobility and physical performance, this investigation explored these relationships. SUBJECTS: Thirty-one men and 26 women, aged 20 to 91 years (chi=58.4, SD=24.4), participated. METHODS: Subjects were assigned to one of three age groups: 20 to 40 years, 60 to 74 years, or 75 years and older. Five sets of variables were identified and measured: cervical, lumbar, sagittal configuration (ie, kyphosis, lordosis), combined spinal motion, and physical performance. RESULTS: A multivariate analysis of variance revealed age effects for all sets of variables; a post hoc analysis of variance revealed age effects for all variables within the sets. Canonical correlations, controlling for age, demonstrated associations between the cervical and combined spinal motion sets of variables and between the combined spinal motion and physical performance sets of variables. CONCLUSION AND DISCUSSION: This investigation demonstrated an age effect for selected measures of axial mobility, sagittal configuration, and physical performance thought to depend on axial motion. Controlling for age, the results also demonstrated associations between measures of axial mobility and physical performance.

Functional and mobility impairments associated with Paget's disease of bone.

OBJECTIVE: To determine if patients with Paget's disease of bone involving the tibia, femur, and/or acetabular portion of the ilium had more impairments in function and mobility than age- and sex-matched control subjects. PATIENTS AND METHODS: A case control study with Paget's disease patients selected from a center for bone disease at a tertiary medical center; control subjects were volunteers from the Duke University Aging Center subject registry. Demographic characteristics, physical examination and serum alkaline phosphatase levels were obtained. Radiographs of the pelvis and lower extremities were evaluated by a radiologist. All participants completed a Functional Status Questionnaire (FSQ). Mobility measures included mobility skills protocol, 10-foot walk time, 360-degree turn left (number of steps), and 6-minute walk distance. RESULTS: The 12 Paget's disease patients were no different in age (70.7 +/- 6.2 years) than the 12 control subjects (69.5 +/- 6.2 years). Serum alkaline phosphatase levels were elevated in Paget's patients (539 +/- 530 IU/L), and normal in control subjects (85 +/- 17 IU/L). In addition to Paget's disease, radiographs showed joint space loss in joints proximate to the diseased bone. On the FSQ scales Paget's disease patients had significantly lower scores in basic activities of daily living (P < .05), instrumental activities of daily living (P < .001), and social activity than control subjects (P < .05). There was no difference between the groups on scales measuring mental health and quality of social interaction. On mobility measurements, Paget's disease patients showed significant impairments when compared with control subjects: mobility skills protocol score (22.5 +/- 2.5 vs 25.6 +/- 0.7, P < .001); 10-foot walk (3.96 +/- 1.3 vs 2.55 +/- 0.5 seconds, P < .001); 360 degree turn left (8.0 +/- 1.0 vs 5.9 +/- 0.6 steps, P < .001); and 6-minute walk (342.0 +/- 108.5 vs 519.4 +/- 100 meters, P < .001). CONCLUSION: When compared with control subjects, patients who have Paget's disease of bone involving the tibia, femur, or acetabular portion of the ilium have clinically and statistically significant functional and mobility impairments compared to age- and gender-matched controls.

Association of osteoporotic vertebral compression fractures with impaired functional status.

PURPOSE: To determine if vertebral compression fractures in elderly women were associated with impairments in physical, functional, and psychosocial performance. SUBJECTS AND METHODS: Ten white women with confirmed vertebral compression fractures were age- and race-matched with 10 control subjects without fractures in a case-control design. All subjects invited to participate in this study were patients of the Geriatrics Division of the Department of Medicine at Duke University Medical Center. All study participants lived either in the community or in the independent-living sections of local retirement communities in and around Durham, NC. Subjects with fractures (mean age = 81.9 years, SD = 5.9 years) had two or more vertebral compression fractures in their medical records, whereas control subjects (mean age = 79.6 years, SD = 6.5 years) had no history of vertebral fractures. Spinal radiographs of all women confirmed group assignment. Physical, functional, and psychosocial performances were evaluated. Physical performance was assessed by measurements of maximal trunk extension torque and thoracic and lumbar spinal motion in the sagittal plane, functional reach, mobility skills, 10-ft timed walk, and 6-minute walk test. Thoracic and lumbar spinal configurations were also determined. Functional performance was assessed using the Functional Status Index. Psychosocial performance was assessed with the following scales: Hopkins Symptom Checklist 90 Revised, Rosenberg Self-Esteem Scale, West Haven-Yale Pain Inventory, Beck Depression Inventory, and single-item health-belief questions. RESULTS: Control subjects were not significantly different from patients with fractures in age, weight, number of current illnesses, number of prescribed medications, number of pain medications, ratings of lumbar spine degenerative disc disease, or lumbar spine facet joint arthritis. Activity levels and exercise participation were similar in both groups. Control subjects had no vertebral fractures, whereas fracture subjects had 4.2 +/- 2.6 fractures (range: 2 to 10). Thoracic kyphosis was increased and lumbar lordosis was reduced in fracture subjects. Fracture subjects had reduced maximal trunk extension torque, thoracic and lumbar spine sagittal plane motion, functional reach, mobility skills, and 6-minute walk test. The Functional Status Index showed reduced levels of functional performance in fracture subjects compared with controls with increased levels of assistance, pain with activity, and difficulty in activities. Psychosocial performance was limited in fracture subjects with increased psychiatric symptoms, increased pain, and greater perception of problems caused by health. CONCLUSION: Vertebral compression fractures are associated with significant performance impairments in physical, functional, and psychosocial domains in older women.