Many of us are aware about the risks that older and elderly people face when they fall. DEXA scans can be a strong clinical tool to assess the risk for fragility fractures but not necessarily fractures related to poor movement strategies. These movements are used to compensate for lack of strength or flexibility and may inadvertently cause vertebral compression fracture (VCF) when an osteoporotic spinal column is inappropriately loaded. The prevalence for a VCF is 25% for women. Shockingly, many are undetected clinically even when shown on a x-ray, only 30% of VCFs are reported.
Deficits in physical performance contribute to the risk for VCF regardless of history. A group took a systematic look at these issues. MacIntyre, a PT/researcher and a group of clinicians from United Osteoporosis Centers have been working with a test that can predict the risk of VCF. Using simple movements that are based on daily household activities such as picking up a newspaper they can predict a patient’s risk for a VCF. It is known as Safe Functional Motion test (SFM). A SFM test can suggest a VCF along with an x-ray to confirm.
SFM test can predict the risk of a VCF. The group looked at men and women over the age of 50 who attended a specialty osteoporosis clinic and saw that the higher the SFM score was the less risk the patient had for a VCF in one year and even less of a risk in three years. So to look at it another way, the less mobile an osteoporotic individual was in the activities of daily living, the higher chance they had for a VCF. The group suggests that the way the spine is stressed and loaded is a better predictor of VCF than predictors currently used for a fall risk would be.
So what does this all this mean? This simple and inexpensive test can serve as an early warning for modifiable interventions for patients who are at risk for VCF. Interventions could prevent osteoporotic fracture and the associated clinical and poor quality of life issues down the line. Of course there are other risks like low bone mineral density or not taking bone-sparing medication that can contribute to the prediction. But even when these latter covariates are controlled for SFM is still a strong predictor, suggesting there are highly modifiable physical movements that can alter the risk for the better. Additionally, the SFM test can be preformed by a certified technician (no MD required) and the intervention can be done with a PT or perhaps a nurse, making it relatively inexpensive. Although more research is needed on which specific interventions are most effective at preventing a VCF, we now may have a simple test to prevent osteoporotic fractures. Since movements that contribute to the risk are ingrained by habit, they can be unlearned as well.
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Sources cited in this blog:
MacIntyre, N. J., et al. “Scores on the Safe Functional Motion test predict incident vertebral compression fracture.” Osteoporosis international 25.2 (2014): 543-550.
Recknor, Chris P., et al. “Scores on the Safe Functional Motion test are associated with prevalent fractures and fall history.” Physiotherapy Canada 65.1 (2013): 75-83.