Al-Sari, U. A.

Clark, E. M.

Tobias, J. H.

SummaryPrevious work has shown that patients with vertebral fractures do less physical activity. However, the association between vertebral fracture and different components of physical activity is unclear. Our results suggest that vertebral fracture (VF) is associated with a reduction in activities involving bending, ambulation, and daily living, regardless of age.IntroductionThe aim of this study was to determine whether osteoporotic VF is associated with reduced self-reported everyday routine physical activity and/or ability (PAA).MethodsA comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the “grey” literature from 1950 to the end of July 2016. Standardised search terms for VF and PAAs were used. Four categories of PAA were included: (1) bending ability, (2) ambulatory activities, (3) reaching arms above shoulder level, and (4) activities of daily living (ADLs). Strict inclusion and exclusion criteria were used, and only studies that adjusted for age were included. For the meta-analysis, pooled OR and 95% confidence interval (CI) were calculated using a random-effects model.ResultsEleven studies in total were identified which had investigated the associations between the prevalent VF and the selected PAAs and expressed these as ORs or RR. Women (six studies) with VF had a 64% increase in difficulty forward bending compared to those without VF. Women (nine studies) with VF had a 27% increase in difficulty doing ambulatory activities, while no association was observed for men (four studies). Women also have 73% (five studies), 127% (three studies), and 100% (four studies) increase in difficulty reaching arms above shoulder, shopping, and preparing meals, respectively.ConclusionStudies consistently show women with VF have reduced everyday activities, while much less research has been carried out in men. This information may be useful when designing interventions to improve physical function in people with osteoporotic VFs

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                          Al-Sari, U. A., Al-Sari, U. A., Tobias, J. H., & Clark, E. M. (2018). Self-reported everyday physical activities in older people with osteoporoticvertebral fractures: a systematic review and meta-analysis. OsteoporosisInternational, 29(1), 19-29. https://doi.org/10.1007/s00198-017-4287-6Peer reviewed versionLink to published version (if available):10.1007/s00198-017-4287-6Link to publication record in Explore Bristol ResearchPDF-documentUniversity of Bristol - Explore Bristol ResearchGeneral rightsThis document is made available in accordance with publisher policies. Please cite only the publishedversion using the reference above. Full terms of use are available:http://www.bristol.ac.uk/pure/about/ebr-termsAppendix 1: Assessment of methodological quality of studies Study Objectively definition of VF The same method of ascertainment for cases and controls Controls selected from the same population Clearly stated inclusion criteria or exclusion criteria Identified time since the last VF Adjusted for back pain Score from    6 Jinbayash et al. Y  Y  Y  Y  N  N  4 Burger et al. Y  Y  Y  Y N  N  4 Greendale et al. N  Y  Y  Y Y  N  4 Huang et al. Y  Y  Y  Y Y  Y  6 O’Neill et al. Y  Y  Y  Y Y  N  5 Edmond et al. Y  Y  Y  Y Y  N  5 Chan et al.  Y  Y  Y  Y N  N  4 Ling et al. Y  Y  Y  Y N  N  4 Silman et al. Y  Y  Y  Y N  N  4 Ismail et al. Y  Y  Y  Y N  N  4 Lau et al. Y  Y  Y  Y N  N 4    Appendix 2: Stage two rejected articles for this systematic review of the association between prevalence of VF and physical activity (n=26)   No control (all patients with VF) (2 studies)  Bergland, A., H. Thorsen, and R. Karesen, Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int, 2011. 22(6): p. 1863-71. Hallberg, I., et al., Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord, 2009. 10: p. 135. All types of fracture were assessed together (hip, wrist, & vertebral) (3 studies)  Wong, A.K., et al., Bone-muscle indices as risk factors for fractures in men: the Osteoporotic Fractures in Men (MrOS) Study. J Musculoskelet Neuronal Interact, 2014. 14(3): p. 246-54. Nixon, A., et al., Osteoporosis Assessment Questionnaire-Physical Function (OPAQ-PF): a psychometrically validated osteoporosis-targeted patient reported outcome measure of daily activities of physical function. Osteoporos Int, 2014. 25(6): p. 1775-84. 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Tracy, J.K., et al., Racial differences in the prevalence of vertebral fractures in older men: the Baltimore Men's Osteoporosis Study. Osteoporos Int, 2006. 17(1): p. 99-104. van der Jagt-Willems, H.C., et al., Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk factors. Age Ageing, 2012. 41(2): p. 200-6. No adjustment for confounding by age (9 studies) Cauley, J.A., et al., Prevalent vertebral fractures in black women and white women. J Bone Miner Res, 2008. 23(9): p. 1458-67. Yamauchi, M., et al., Increased low-density lipoprotein cholesterol level is associated with non-vertebral fractures in postmenopausal women. Endocrine, 2015. 48(1): p. 279-86. Cho, S.K., et al., The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis. J Korean Med Sci, 2014. 29(6): p. 859-63. Schousboe, J.T., et al., Association between prior non-spine non-hip fractures or prevalent radiographic vertebral deformities known to be at least 10 years old and incident hip fracture. J Bone Miner Res, 2006. 21(10): p. 1557-64. Clark, E.M., R. Gooberman-Hill, and T.J. Peters, Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes. Osteoporos Int, 2016. 27(4): p. 1459-67. Cooper, C., et al., Screening for vertebral osteoporosis using individual risk factors. The Multicentre Vertebral Fracture Study Group. Osteoporos Int, 1991. 2(1): p. 48-53. Black, D.M., et al., Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res, 1999. 14(5): p. 821-8. Tsang, S.W., et al., Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture. Osteoporos Int, 2011. 22(2): p. 667-74. Kwok, A.W., et al., Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int, 2013. 24(3): p. 877-85.  Addendix 3: Prisma 2009 Checklist Section/topic  # Checklist item  Reported on page #  TITLE   Title  1 Identify the report as a systematic review, meta-analysis, or both.  Page 1  ABSTRACT   Structured summary  2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.  Page 2  INTRODUCTION   Rationale  3 Describe the rationale for the review in the context of what is already known.  Page 3 Objectives  4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).  Page 4 METHODS   Protocol and registration  5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.  Page 5 Eligibility criteria  6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.  Table 1   Information sources  7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.  Page 5 Search  8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.  Page 5 Study selection  9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).  Figure 1   Data collection process  10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.  Page 6 Data items  11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.  Page 5 Risk of bias in individual studies  12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.  Page 6  Summary measures  13 State the principal summary measures (e.g., risk ratio, difference in means).  Page 6  Synthesis of results  14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.  Page 6   Page 1 of 2  Section/topic  # Checklist item  Reported on page #  Risk of bias across studies  15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).  Page 6  Additional analyses  16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.  Page 7  RESULTS   Study selection  17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.  Page 8  Study characteristics  18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.  Page 8  Risk of bias within studies  19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12).  Appendix 1 Results of individual studies  20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.  Figure 2, 3, 4, 5 Synthesis of results  21 Present results of each meta-analysis done, including confidence intervals and measures of consistency.  Pages 9, 10, 11 Risk of bias across studies  22 Present results of any assessment of risk of bias across studies (see Item 15).  Page 8  Additional analysis  23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]).  Page 8  DISCUSSION   Summary of evidence  24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).  Page 12 Limitations  25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).  Page 13 Conclusions  26 Provide a general interpretation of the results in the context of other evidence, and implications for future research.  Page 13  FUNDING   Funding  27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.  N/A  Part of PhD  From:  Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097  For more information, visit: www.prisma-statement.org.  Page 2 of 2             

Self-reported everyday physical activities in older people with osteoporotic vertebral fractures:a systematic review and meta-analysis

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Self-reported everyday physical activities in older people with osteoporotic vertebral fractures:a systematic review and meta-analysis

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