Exploring the association between number, severity, location of fracture, and occiput-to-wall distance

Christina Ziebart, Jonathan D. Adachi, Maureen C. Ashe, Robert R. Bleakney, Angela M. Cheung, Jenna C. Gibbs, Keith D. Hill, David L. Kendler, Aliya A. Khan, Sandra Kim, Caitlin McArthur, Nicole Mittmann, Alexandra Papaioannou, Sadhana Prasad, Samuel C. Scherer, Lehana Thabane, John D. Wark, Lora M. Giangregorio

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Summary: This study of women with a suspected vertebral fracture determined the association between vertebral fracture characteristics and posture. The number of fractures was associated with posture. Severity of fracture was associated with posture when adjusting for pain. Fracture characteristics explain some variability in posture in women with a suspected vertebral fracture. Purpose: Osteoporotic vertebral fractures are associated with increased morbidity and mortality. An accumulation of vertebral fractures may lead to forward head posture, which has been independently associated with mortality. It is unclear how fracture characteristics, including the number, severity, and location of fracture, contribute to occiput-to-wall distance (OWD). Methods: This was a cross-sectional secondary data analysis using baseline data from a randomized controlled trial, in community-dwelling women aged 65 years and older with a suspected vertebral fragility fracture. Lateral thoracic and lumbar spine radiographs were used to determine the number, location, and severity of fracture. Occiput-to-wall distance (OWD) was used to assess forward head posture. Pain during movement (0–10 scale) and age were considered as confounding variables. Multivariable regression models were used to evaluate relationships between fracture variables and OWD. Results: Participants (n = 158) were of mean age 75.9 (SD 6.5) years with a mean (SD) BMI = 26.7 (5.3) kg/m 2 , OWD = 5.7 (4.6) cm, and number of fractures = 2.4 (2.4). In unadjusted analyses, the number of fractures (B = 0.82, 95% CI = 0.04, 1.59) was associated with OWD. When adjusting for pain, severity of fractures (B = 1.08, 95% CI = 0.001, 2.15) was independently associated with OWD. Location was not associated with OWD in any of the models. Conclusions: The number of fractures was significantly associated with OWD in the unadjusted model, explaining more of the variability in OWD than other fracture characteristics. Severity of fracture was associated with OWD in the adjusted model. However, pain may confound the relationship between OWD and fracture characteristics.

Original languageEnglish
Article number27
Number of pages8
JournalArchives of Osteoporosis
Issue number1
Publication statusPublished - 28 Feb 2019
Externally publishedYes


  • Hyperkyphosis
  • Older adults
  • Osteoporosis
  • Posture
  • Vertebral fractures

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