title: Undiagnosed vertebral fractures influence quality of life in postmenopausal women with reduced ultrasound parameters.
abstract: BACKGROUND
  Osteoporosis, a multifactorial systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to increased bone fragility, is a worldwide public health problem. Vertebral fractures affect approximately 20% of postmenopausal women and are a hallmark of osteoporosis, but they may pass unnoticed, although they may lead to long-term immobility and disability.
  
  
  OBJECTIVE
  The aims of the present study were (1) to determine the prevalence and the severity of vertebral fractures in a large cohort of Italian women aged 60 years or older with reduced values of quantitative ultrasound parameters; and (2) to assess whether vertebral fractures and other variables may be associated with health-related quality of life.
  
  
  METHODS
  A total of 2450 women without back pain aged 60 years or older, after the completion of the Quality of Life Questionnaire of the European Foundation for Osteoporosis QUALEFFO, underwent quantitative ultrasound evaluation of the calcaneus; in those with a stiffness t-score of ≤ -2 (n = 1194), radiographic evaluation of the thoracic and lumbar spine was carried out and then quantitative morphometry was performed by dedicated software (MorphoXpress). The radiographic analysis was carried out on 885 women who presented films of adequate quality. Multivariate regression was used to adjust for confounding variables.
  
  
  RESULTS
  Of those who underwent radiographic analysis, 681 had no vertebral fractures, and 204 women (23.1%) had one or more previously undiagnosed vertebral fractures. The prevalence of previously undiagnosed vertebral fractures increased with advancing age with more than 30% of women older than 75 years having at least one fracture. Older age, body mass index, and severe vertebral fractures were independently associated with a worse total QUALEFFO score.
  
  
  CONCLUSIONS
  We found that approximately one in four women showed evidence of undiagnosed vertebral fractures, and there was a strong age effect trend. Moreover, the severity grade of vertebral fractures, more than the number of fractures, was associated with a worsening of health-related quality of life as assessed by QUALEFFO. These findings confirm the clinical relevance of an early diagnosis of vertebral fractures and seem to support the usefulness of quantitative ultrasound measurements in the stratification of postmenopausal women at increased fracture risk.
  
  
  METHODS
  Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Internal Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.forename: Carla
authors.initials: C
authors.lastname: Caffarelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.forename: Luigi
authors.initials: L
authors.lastname: Gennari
authors.forename: Stefano
authors.initials: S
authors.lastname: Gonnelli
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017698:Postmenopause; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D013997:Time Factors; D014463:Ultrasonography
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