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The association of osteoporosis and geriatric syndromes in the elderly: data from the Russian epidemiological study EVKALIPT

The association of osteoporosis and geriatric syndromes in the elderly: data from the Russian... Summary Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients. Purpose To analyze associations of osteoporosis with geriatric syndromes in patients aged 65 years and older in the Rus- sian Federation. Methods A total of 4308 patients (30% men) aged 65–107 years were examined and distributed into 3 age groups (65– 74 years, 75–84 years, and 85 years and older). All patients underwent a comprehensive geriatric assessment. In the “Falls and risk of falls” module, the number and circumstances of falls over the previous year were analyzed, as well as the history of fractures. The presence of osteoporosis was determined based on medical records. Physical examination included anthro- pometric measurements and standard enquiry, short physical performance battery (SPPB), dynamometry, measurement of gait velocity, Mini-Cog test, and orthostatic test. Results A total of 507 patients (11.8%) had evidence of osteoporosis; indications of low-energy fractures in history were recorded in 739 (17.3%) patients. Patients with osteoporosis were older, shorter, and predominantly women; had a lower body weight and a higher Charlson comorbidity index; and took more drugs. Patients with osteoporosis had lower gait velocity, hand grip strength, Barthel index value, and scores of the Lawton instrumental activities of daily living scale, the MNA (Mini Nutritional Assessment) short-form, and the SPPB. Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Conclusions Osteoporosis is associated with almost all GSs. The association of osteoporosis with advanced GSs aggravates the condition of these patients. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients: early detection and correction of osteoporosis. Keywords Older age · Osteoporosis · Fractures · Geriatric syndromes Introduction the middle of the twenty-first century (2050), it will be at least 27% [1]. As the population rapidly ages, interest in The global population is aging, and the proportion of the age-related diseases and geriatric syndromes (GSs) also elderly people is registered in on the rise worldwide. In the rises. GS is a multifactorial age-associated clinical condi- middle of the twentieth century, the proportion of people tion that worsens the quality of life and increases the risk of over 65 years of age was 7.7% of the world’s population; adverse outcomes (death, dependence on external assistance, over the first 20 years of the next century, the proportion repeated hospitalizations, and need for long-term care) and of people of this age increased to 19% (2019 data), and by functional disorders [2, 3]. Age-associated diseases and GSs include disease such as osteoporosis. The term “osteopo- rosis” was used in France in the early nineteenth century * Julia S. Onuchina and implied bone pathology. Osteoporosis is classified by onuchina90@list.ru WHO as one of the five most significant human diseases Extended author information available on the last page of the article Vol.:(0123456789) 1 3 30 Page 2 of 11 Archives of Osteoporosis (2023) 18:30 alongside infarction, stroke, cancer, and sudden death. In the number of participants and their distribution by age groups mid-2000s, 33.8% of women and 26.9% of men in Russia in individual regions did not always correspond to the over the age of 50 have osteoporosis. Extrapolation of the planned. The majority (60%) of the participants were exam- entire population of the Russian Federation revealed 14 mil- ined in a clinic, every fifth in a hospital (20%) or at home lion patients, which is about 10% of the population [4]. At (19%), and 1% in nursing homes. present, the social significance of osteoporosis is recorded, This data is a part of a large epidemiological study of determined by its consequences, namely low-trauma frac- EVKALIPT conducted in the Russian Federation. Russian tures of the vertebral bodies and bones of the peripheral EVKALIPT study protocol and basic characteristics of par- skeleton, leading to high healthcare burden as well as sig- ticipants are summarized in the article [7]. nificant impairments such as disability and mortality [5 , 6]. All patients underwent a comprehensive geriatric assess- At the same time, the exact prevalence of osteoporosis is ment (CGA) in two stages: (1) survey based on a specially unknown due to the fact that in most cases, only fractures designed questionnaire and (2) physical examination. This of the proximal femur are recorded, including in elderly was performed simultaneously by a geriatrician and a geri- patients. atric nurse at the patient’s residence (in a hospital, clinic, In Russia, data on osteoporosis is old, and generally residential institution/assisted-living facility, or at home). relates to particular regions, that is why it needs to provide The questionnaire included the “Socio-economic sta- new investigation. tus,” “Occupational history,” “Risk factors for chronic non- In 2018, the EVKALIPT (Epidemiological study of the communicable diseases,” “Chronic non-communicable prevalence of GSs and age-associated diseases in the elderly diseases,” “Drug therapy,” “Obstetrics and gynecological patients in regions of the Russian Federation with different history,” “Falls and risk of falls,” “Chronic pain,” “Sensory climatic, economic, and demographic characteristics) study deficits,” “Oral health,” “Urine and fecal incontinence,” among patients aged 65 years and older was started, aimed “Use of aids,” “Laboratory examination results,” and a at obtaining the prevalence of age-associated diseases, frailty number of standardized scales: screening scale “Age is not syndrome, other GSs, osteoporosis, and fractures, as well as a problem,” the Geriatric Depression Scale GDS-15, Basic analysis of their contribution to parameters of general health Functional Activity Scale (Barthel Index), Lawton Instru- and functional status in Russia. The study was performed mental Activities of Daily Living Scale, MNA (Mini Nutri- from 2018 to 2020 in 11 regions of Russia at the initiative tional Assessment) short-form, Charlson comorbidity index, of the Russian Association of Gerontologists and Geriatri- and Visual Analog Scale (VAS) for self-assessment of qual- cians and the Russian Gerontological Research and Clinical ity of life, health status, and intensity of pain syndrome at Center in cooperation with the National Research University the time of the examination and during their stay. Higher School of Economics. For screening frailty in daily practice in Russia, they developed the questionnaire “Vozrast ne pomekha” (VNP), which translates into English as “Age is not a hindrance.” Materials and methods The study questionnaire was composed of seven dichoto- mous items for evaluation of the following characteris- In a cross-sectional analytical epidemiological study, tics: weight loss (“Did you lose 5 kg or more in the past EVKALIPT included patients aged from 65 to 107 years 6  months?”), impaired vision or hearing (“Do you have (mean age 78 ± 8 years), from April 2018 to October 2019, any restrictions in daily living due to decreased vision or who live in 11 Russian regions (Republics of Bashkorto- hearing?”), fall-related injuries (“Have you had any injury- stan, Dagestan, and Chuvashia; Voronezh and the Voronezh related falls during the last year?”), mood disorder (“Have region; Moscow; Saratov; St. Petersburg and the Leningrad you felt depressed, sad or anxious over the past weeks?”), region; Ivanovo, Ryazan, Samara, and Smolensk region). cognitive impairment (“Do you have problems with mem- Inclusion criteria were age of 65 years or older and writ- ory, comprehension, orientation or ability to plan?”), urinary ten voluntary informed consent to participate in the study. incontinence (“Do you have urinary incontinence?”), and In accordance with the protocol, participants were dis- difficulty walking (“Do you have any difficulty walking at tributed into three age groups (65–74 years, 75–84 years, home or on the street up to a distance of 100 m, or climbing and ≥ 85 years). a flight of stairs?”). One point was recorded for each positive Initially, it was planned to include 600 people from each answer, so the total score ranged from 0 to 7 [8]. A score region (200 participants in each age group) in the study. of ≥ 5 indicates a high probability of frailty syndrome. This However, only a small number of participants were included questionnaire underwent a validation process, and the results in this way. Most of the participants were recruited on the of that process were published previously and are presented basis of seeking medical care, i.e., planned inpatient treat- in abridged form here [9]. This scale was added in clinical ment in geriatric departments/hospitals, so the actual total guidelines on frailty in Russia [10]. 1 3 Archives of Osteoporosis (2023) 18:30 Page 3 of 11 30 The physical examination included (1) short physical per- (4) malnutrition, (5) orthostatic hypotension, (6) urinary formance battery tests (SPPB), (2) dynamometry, (3) meas- incontinence, (7) fecal incontinence, (8) functional disor- urement of gait velocity, (4) Mini-Cog test, (5) measurement ders, (9) loss of autonomy, (10) falls (for the previous year), of height and body weight, calculation of body mass index (11) vision deficit, (12) hearing loss, (13) sensory deficit (BMI), (6) measurement of blood pressure (BP) and heart (any), (14) chronic pain syndrome, and (15) bedsores. rate (HR), and (7) orthostatic test. Osteoporosis was diagnosed if in medical history is reg- All tests, scales, and questionnaires used in the study istered a low-trauma (i.e., fragility) fracture of major bones (with the exception of the Charlson comorbidity index) are (vertebral or proximal femur fracture or multiple fracture), in the Russian clinical guidelines “Frailty syndrome” [10, increased fracture risk using FRAX® (Fracture Risk Assess- 11]. The detailed study protocol and baseline characteristics ment Tool) Russian-specific threshold, or if patient had of the participants have been presented in our previously results of Bone Densitometry with T-score − 2.5 or below published article [7]. in the lumbar spine, femoral neck, total proximal femur, The “Falls and risk of falls” module considered the num- or patient’s information. A fragility fracture was mean as ber and circumstances of falls over the previous year, as a fracture sustained from low-energy trauma, such as a fall well as the history of fractures (fractures of the vertebrae, from standing height or less, that would not have occurred in femur, and radius when falling from standing height and healthy bone, excepting fractures of the skull, face, fingers, their number, surgical treatment for fractures of the verte- and toes. brae, the need for care due to fracture, fracture of the femoral neck in parents). Characteristics of the participants The physician assessed cognitive function and completed the modules “Chronic non-communicable diseases,” “Drug The study included 4308 patients (30% men) aged therapy,” “Obstetrics and gynecological history,” and “Labo- 65–107 years (Table 1). The majority (60%) of participants ratory examination results.” The nurse completed all other were examined in a polyclinic setting, 20% examined in a modules and the physical examination. hospital, 19% at home, and 1% in residential institutions/ The presence of the following GSs was determined: (1) assisted-living facilities. Among those examined, over- frailty syndrome, (2) cognitive impairment, (3) depression, weight patients prevailed (41%), while the proportion of Table 1 Demographic, anthropometric, and clinical characteristics of patients aged 65 years and older (values in bold indicates statistical difference) Parameter All patients (n = 4308) Age groups p for trend 65–74 years (n = 1583) 75–84 years (n = 1519) ≥ 85 years (n = 1206) Age, years (M ± SD) 78.3 ± 8.4 69.1 ± 2.6 79.4 ± 2.5 88.9 ± 3.3 - Male gender, % 29.7 31.9 27.3 29.9 0.020 Height, m (M ± SD) 1.63 ± 0.09 1.64 ± 0.08 1.62 ± 0.08 1.61 ± 0.09 < 0.001 Weight, kg (M ± SD) 73.9 ± 14.3 78.3 ± 14.5 73.3 ± 13.3 68.9 ± 13.2 < 0.001 Body mass index, kg/m 27.9 ± 5.0 29.0 ± 5.2 27.9 ± 4.9 26.6 ± 4.4 < 0.001 (M ± SD) Body mass, %   Deficit 1.3 1.0 0.9 2.2 0.007   Norm 27.6 21.3 28.4 34.7 < 0.001   Excess 40.9 41.1 39.6 42.2 0.414   Obesity 30.2 36.6 31.1 21.0 < 0.001 Degrees of obesity, % (n = 1264)   I 72.2 66.8 75.0 78.8 0.001   II 21.6 24.2 20.2 18.4 0.118   III 6.3 9.0 4.8 2.8 0.001 Systolic blood pressure, mm Hg 136.1 ± 16.5 136.4 ± 16.6 136.0 ± 16.0 135.8 ± 17.0 0.819 (M ± SD) Diastolic blood pressure, mm Hg 80.2 ± 9.5 81.6 ± 9.5 80.1 ± 9.2 78.5 ± 9.7 < 0.001 (M ± SD) Pulse blood pressure, mm Hg 55.9 ± 13.0 54.8 ± 12.5 55.8 ± 12.4 57.3 ± 14.0 < 0.001 (M ± SD) Heart rate, beats/min (M ± SD) 72.7 ± 8.6 72.6 ± 8.3 73.0 ± 9.1 72.3 ± 8.3 0.111 1 3 30 Page 4 of 11 Archives of Osteoporosis (2023) 18:30 patients with obesity and normal body weight was similar 292 (39.6%) had a fracture of the proximal femur, 464 (63%) (30% and 28%), and 1.3% of participants were underweight had a fracture of the radial bone, and 158 (21.5%) had a (Table 1). Among patients with obesity, the majority of par- fracture of the vertebrae. We noted a decrease in the propor- ticipants were obesity type I. With an increase in age, there tion of patients undergoing surgical treatment for vertebral is a decrease in height, body weight, BMI, the proportion fractures alongside (Table 2); there were no differences in of obese patients, and the severity of obesity, as well as an other parameters across the age groups. increase in the proportion of patients with normal weight. Among patients without documented osteoporosis The proportion of overweight patients was identical in all (n = 3788), 594 (15.7%) presented with low-energy frac- age groups. The mean values of systolic and diastolic BP tures in history: thus, these patients also had osteoporosis not and heart rate were within the normal range in all patients; diagnosed in a timely manner. For further analysis, patients however, diastolic BP also decreased with age and pulse with documented osteoporosis and with a history of frac- BP increased with similar identical values of systolic BP tures were combined into one group (group with osteoporo- and HR. sis; n = 1101). The osteoporosis group accounted for 25.6% of all patients. Comparison group consisted of patients Statistical data analysis without documented osteoporosis or history of low-energy fractures (group without osteoporosis; n = 3168). Increased The study was performed using IBM® SPSS® Statistics prevalence of osteoporosis increased significantly with age version 23.0 (SPSS Inc., USA). The type of distribution of (Fig. 1). quantitative variables was analyzed using the one-sample Patients with osteoporosis were older, shorter, and Kolmogorov–Smirnov test. Results of parametric data were predominantly females; had a lower BMI and a higher presented as M ± SD, where M is the mean, and SD is the Charlson comorbidity index; and took much more drugs standard deviation; while that of non-parametric data, the (Table 3). results are presented as Me (25%; 75%), where Me is the According to the results of CGA, patients with osteo- median, and 25% and 75% are the 25th and 75th percentiles. porosis had lower gait velocity, hand grip strength, Bar- For clarity, some variables are presented simultaneously as thel index value, Lawton Instrumental Activities of Daily Me (25%; 75%) and M ± SD. For intergroup comparisons, Living Scale scores, MNA (Mini Nutritional Assessment) the Mann–Whitney, Kruskal–Wallis, and Pearson’s χ tests, short-form, and SPPB. However, they presented with as well as Fisher’s two-tailed exact test, were used. Relation- higher Geriatric Depression Scale and the screening scale ships between variables were assessed using binary logistic “Age is not a problem” scores. Patients with osteoporosis regression with the odds ratio (OR) and 95% confidence presented with lower quality of life and health status, and interval (CI). One-way and multivariate regression analy- higher intensity of pain syndrome at the time of examina- ses were performed after adjusting for age and gender. We tion as well as 7 days prior to examination (Table 4). analyzed the variables using the direct stepwise selection Patients with osteoporosis used assistive products more method of multivariate analysis. Differences were consid- often (with the exception of spectacles/lenses which, how- ered significant at a two-tailed p < 0.05. ever, they tended to use more frequently), and their number per patient was significantly higher than in those without osteoporosis (Table 5). Results Patients with osteoporosis showed a higher incidence of all GSs, except for orthostatic hypotension and hearing The presence of osteoporosis was determined based on past loss (Table 6); and the most common GSs were chronic medical records. Information related to chronic disease was pain syndrome (95%), basic dependence in everyday life present for 4295 (99.7%) participants, and 507 (11.8%) were (71%), frailty syndrome (68%), cognitive impairment osteoporotic. Information about drugs was known in 501 (65%), instrumental dependence in everyday life (58%), (98.8%) patients with osteoporosis, and almost half (49.1%) probable depression (57%), and urinary incontinence of them were not on treatment of osteoporosis. Among all (57%). patients treated with drugs, the majority (91.4%) were on A one-way regression analysis adjusted for age and calcium and vitamin D supplements, 12 (4.7%) patients gender. GSs were considered as a dependent variable, received antiresorptive therapy, 1 (0.4%) patient received and the presence of osteoporosis, age (as an extended bone anabolic therapy, and 9 (3.5%) patients received antire- variable), and gender were independent variables. Results sorptive and bone-metabolic therapy. demonstrated that osteoporosis is associated with almost Information related to the history of fragility fractures all GSs, with the exception of orthostatic hypotension, was available in 4275 (99.2%) participants. A history of fra- hearing loss, and cognitive impairment (OR from 1.19 to gility fractures was recorded in 739 (17.3%) patients, and 3.10) (Table 7). 1 3 Archives of Osteoporosis (2023) 18:30 Page 5 of 11 30 Table 2 Incidence of low-energy fractures in history in patients aged 65 years or older (values in bold indicates statistical difference) Parameter All patients Age groups p for trend (n = 4308) 65–74 years 75–84 years ≥ 85 years (n = 1583) (n = 1519) (n = 1206) History of low-energy fractures, % 17.3 15.9 17.7 18.6 0.148 Proximal femur fractures due to a fall from standing height in history, % 6.8 6.0 6.5 8.2 0.057 Surgical treatment for proximal femur fracture in history, % (n = 290) 57.6 58.1 60.6 54.1 0.647 Fractures of the radial bone due to a fall from standing height in history, % 10.8 9.8 11.5 11.3 0.257 Number of fractures of the radial bone due to a fall from standing height in 0.022 history, % (n = 432) 1 80.8 87.5 75.0 80.5 2 or more 19.2 12.5 25.0 19.5 History of vertebral fractures due to a fall from standinsg height, % 3.7 3.2 3.7 4.3 0.289 Number of vertebral fractures due to a fall from standing height in history, % 0.562 (n = 72) 1 86.1 91.3 80.8 87.0 2 or more 13.9 8.7 19.2 13.0 Surgical treatment for a vertebral fracture in history, % (n = 139) 33.8 46.5 34.7 21.3 0.040 Need for care due to a fracture, % (n = 154) 0.227 No 23.4 33.3 21.8 15.7 Yes, cared for by a nurse 12.3 8.3 10.9 17.6 Yes, cared for by relatives 64.3 58.3 67.3 66.7 Proximal fracture in parents, % 3.4 3.6 3.4 3.1 0.817 p for trend < 0.001 Fig. 1 Prevalence of osteoporo- 29.1 р для тренда <0,001 sis in patients aged 65 years and older according to age groups 26.2 (patients with documented osteoporosis and with a history of fractures) 22.9 Years 65-74 года 75-84 года ≥85 лет Years Years Multivariate regression analysis (adjusted for age presence of osteoporosis was considered a dependent and gender) included 12 GSs with a significance level variable, and GSs, age (as an extended variable), and of p < 0.05 based on the results of one-way analysis; the gender were considered independent variables. Multivariate 1 3 % patients examined % обследуемых 30 Page 6 of 11 Archives of Osteoporosis (2023) 18:30 Table 3 Demographic, Indicator Osteoporosis No osteoporosis p anthropometric, and (n = 1101) (n = 3168) clinical characteristics according to the presence Age, years (M ± SD) 79.2 ± 8.4 78.0 ± 8.4 < 0.001 or absence of osteoporosis Female gender, % 81.7 66.4 < 0.001 in patients aged ≥ 65 years Height, m (M ± SD) 1.61 ± 0.08 1.63 ± 0.09 < 0.001 (n = 4269) (values in bold indicates statistical difference) Weight, kg (M ± SD) 72.1 ± 15.2 74.5 ± 13.9 < 0.001 Body mass index, kg/m (M ± SD) 27.7 ± 5.2 28.0 ± 4.9 0.026 Body mass, %   Deficit 1.6 1.2 0.374   Norm 29.1 27.0 0.192   Excess 41.4 40.7 0.689   Obesity 27.9 31.0 0.055 Degrees of obesity, % (n = 1256)  I 68.5 73.3 0.105   II 24.2 20.9 0.229   III 7.4 5.8 0.337 Charlson comorbidity index [Me (25%; 75%)] 5 (4; 7) 4 (3; 6) < 0.001 Charlson comorbidity index ≥ 5 points, % 60.0 49.0 < 0.001 Number of drugs 6 (4; 8) 5 (3; 7) < 0.001 Number of drugs ≥ 5, % 68.2 56.0 < 0.001 Table 4 Results of CGA according to the presence or absence of osteoporosis in patients aged ≥ 65  years (n = 4269)  (values in bold indicates statistical difference) Indicator Osteoporosis (n = 1101) No osteoporosis (n = 3168) p Screening scale “age is not a problem.” points* 3 (2; 4) 2 (1; 4) < 0.001 SPPB. points * 5 (2; 8) 6 (3; 9) < 0.001 Hand grip strength. kg* 20 (15; 26) 22 (16; 30) < 0.001 15 (10; 20) 16 (11; 22) < 0.001 Decrease in hand grip strength. % 73.7 69.8 0.022 Gait velocity. m/s* 0.57 (0.44; 0.82) 0.64 (0.47; 0.83) 0.026 Decrease in gait velocity. % 57.7 55.4 0.220 Basic activity scale in everyday life (Barthel index). points 95 (80; 100) 95 (90; 100) < 0.001   Me (25%; 75%) 85.3 ± 19.7 89.7 ± 17.0   M ± SD Lawton Instrumental Activities of Daily Living Scale. points 7 (5; 8) 7 (5; 8) < 0.001   Me (25%; 75%) 6.0 ± 2.2 6.3 ± 2.1   M ± SD MNA (Mini Nutritional Assessment) short-form (screening part). points 12 (10; 13) 12 (11; 13) < 0.001   Me (25%; 75%) 11.1 ± 2.2 11.8 ± 2.1   M ± SD Mini-cog test. points* 3 (2; 4) 3 (2; 4) 0.283 Geriatric depression scale points* 5 (3; 9) 4 (2; 7) < 0.001 Self-assessment of the quality of life according to VAS. points* 6 (5; 8) 7 (5; 8) < 0.001 Self-assessment of health status according to VAS. points* 5 (4; 7) 6 (5; 7) < 0.001 Self-assessment of pain at the time of examination according to VAS. points* 4 (1; 5) 3 (0; 5) < 0.001 Self-assessment of pain for the last week according to VAS. points* 5 (3; 7) 4 (1; 6) < 0.001 Results are presented as Me (25%; 75%) analysis revealed that five of them were independently in men (Table 8). The order of variables inclusion in the associated with osteoporosis and the likelihood of the model was as follows: falls in the previous year, female occurrence of osteoporosis was multiplied 1.2–2.5 times, gender, chronic pain syndrome, malnutrition, urinary and in women, the risk of osteoporosis is 84% higher than incontinence, and probable depression. 1 3 Archives of Osteoporosis (2023) 18:30 Page 7 of 11 30 Table 5 Frequency of use of assistive products according in relation to the occurrence of osteoporosis in patients aged ≥ 65 years (values in bold indicates statistical difference) Indicator Osteoporosis No osteoporosis p (n = 1101) (n = 3168) Use of aids, % 95.7 91.5 < 0.001 Number of aids <   Me (25%; 75%) 2 (2; 4) 2 (1; 3) 0.001   M ± SD 2.8 ± 1.6 2.1 ± 1.3 Spectacles/lenses, % 81.1 78.8 0.097 Hearing aid, % 8.7 6.8 0.040 Dentures, % 65.3 57.9 < 0.001 Cane, % 39.3 30.4 < 0.001 Crutches, % 3.6 2.0 0.002 Walkers, % 5.6 3.4 0.001 Wheel-chair, % 2.9 1.5 0.002 Orthopedic shoes, % 10.4 3.2 < 0.001 Orthopedic insoles, % 19.4 6.9 < 0.001 Spinal brace, % 9.9 2.9 < 0.001 Incontinence pads, % 19.6 11.8 < 0.001 Diapers/underpads, % 8.9 4.8 < 0.001 Assistive devices to facilitate mobility (cane, crutches, walkers, wheel-chair), % 44.1 33.4 < 0.001 Absorbent underwear for urinary/fecal incontinence (incontinence pads, diapers, 24.2 14.6 < 0.001 underpads), % Table 6 Incidence of geriatric Indicator Osteoporosis No osteoporosis p syndromes in relation to (n = 1101) (n = 3168) osteoporosis in patients aged ≥ 65 years (values in bold Chronic pain syndrome 95.1 84.5 < 0.001 indicates statistical difference) Basic dependence in everyday life 70.8 57.9 < 0.001 Instrumental dependence in everyday life 57.9 53.0 0.005 Frailty syndrome 68.0 60.8 < 0.001 Cognitive impairments 65.0 59.5 0.003 Probable depression 57.2 45.0 < 0.001 Urinary incontinence 57.3 41.1 < 0.001 Falls over the previous year 45.4 25.1 < 0.001 Sensory deficit (any) 18.2 14.5 0.004 Hearing loss 13.1 11.4 0.145 Vision deficit 6.8 4.5 0.002 Malnutrition 10.0 4.5 < 0.001 Orthostatic hypotension 8.1 7.9 0.845 Fecal incontinence 7.6 3.9 < 0.001 Bedsores 3.5 1.9 0.002 osteoporosis; however, it was not diagnosed in time. For Discussion further analysis, these patients were combined into one group with patients with registered osteoporosis (osteo- The presented subanalysis of data of the Russian epide- porosis group: n = 1101). Consequently, the prevalence of miological study EVKALIPT reveals that the prevalence osteoporosis in patients aged 65 years and older increases of osteoporosis in patients based on the survey was 11.8% to 25.6% with a predominance in women. Most guide- (n = 507). In addition, a group of patients with a his- lines and publications include information obtained in tory of low-energy fractures (n = 594; 15.7%) was iden- the early 2000s based on the results of a cluster cross- tified according to modern criteria, and also who had sectional study in a random sample of one of the districts 1 3 30 Page 8 of 11 Archives of Osteoporosis (2023) 18:30 Table 7 Association between osteoporosis and geriatric syndromes in of osteoporosis. The lack of information about instrumen- patients aged ≥ 65 years (one-way regression analysis as adjusted for age tal examination, and in particular densitometry, limits our and gender) (n = 4269 (values in bold indicates statistical difference) data obtained. In 2017–2018, in the USA, the prevalence Geriatric syndromes OR 95% CI p of osteoporosis in patients over 65 years old was studied based on instrumental data alone (low BMD according to Instrumental dependence in everyday 1.19 1.02–1.39 0.027 densitometry results), and it amounted to 17.7% [14]. In a life European study, among patients of all ages with osteopo- Sensory deficit (any) 1.22 1.00–1.48 0.047 rosis diagnosed based on a decrease in BMD in the femur, Frailty syndrome 1.22 1.04–1.42 0.013 the overall prevalence was 5.6% [15]. Vision deficit 1.44 1.06–1.94 0.018 According to Russian experts in the field of epidemiol- Probable depression 1.52 1.32–1.75 < 0.001 ogy, it has been established that the prevalence of osteopo- Basic dependence in everyday life 1.53 1.31–1.80 < 0.001 rosis in women in the Russian Federation is comparable to Urinary incontinence 1.66 1.43–1.92 < 0.001 global data, and Russian women are of average risk of osteo- Fecal incontinence 1.94 1.45–2.60 < 0.001 porosis on a pair with residents of North America and West- Bedsores 1.97 1.29–3.01 0.002 ern Europe, and in Russian men, it exceeds the prevalence Malnutrition 2.28 1.75–2.97 < 0.001 of osteoporosis in North America and Western Europe [4]. Falls over the previous year 2.28 1.97–2.64 < 0.001 In the EVKALIPT study, women obviously predominated Chronic pain syndrome 3.10 2.32–4.16 < 0.001 in the osteoporosis group among patients aged 65 years and Dependent variable: geriatric syndromes older (Table 3). Thus, in general, the prevalence of osteo- porosis in Russia is comparable to that in other countries. The social and medical significance of osteoporosis is Table 8 Associations between osteoporosis and geriatric syndromes in determined by the fractures caused by it [5]. In the EVKA- patients aged ≥ 65  years (multivariate regression analysis as adjusted for age and gender) LIPT study, 17% of patients had a history of low-energy fractures (Table 2). According to localization, fractures of Predictors OR 95% CI p the radial bone in the history prevailed (10.8%), proximal Female gender 1.84 1.54–2.20 < 0.001 femur fractures were less common (6.8%), and fractures of Probable depression 1.19 1.02–1.38 0.027 the vertebrae due to a fall from standing height in the his- Urinary incontinence 1.37 1.18–1.59 < 0.001 tory rarely occurred (3.7%) (Table 2). Fractures of the radial Malnutrition 1.91 1.45–2.52 < 0.001 bone were more common in patients aged 75–84 years, and Falls over the previous year 1.94 1.67–2.25 < 0.001 fractures of the proximal femur and vertebrae were regis- Chronic pain syndrome 2.46 1.83–3.32 < 0.001 tered more often in patients older than 85 years. At the age Dependent variable: osteoporosis of 50 years, the probability of fracture of the proximal femur during the subsequent life in the Russian Federation is 4% for men and 7% for women. In 2010, the number of fracture of Moscow, when osteoporosis was diagnosed in patients cases of the proximal femur in Russia was 112,000 cases; by aged 50 years and older based on changes in DXA densi- 2035, due to increased life expectancy alone, it will increase tometry in spine and/or proximal femur, and was detected by 36% in men and 43% in women, and will amount to 159 in 33.8% of women and 26.9% of men [4]. However, we thousand cases per year [16]. According to available statis- examined the indices of patients 15 years younger in this tics, the prevalence of bone fractures in Russia is 18.6 cases study. The prevalence of osteoporosis is known to increase per 1000 adult population, or 21.5% [4], which is somewhat with age [12]. In our study, this trend was also demon- higher than in our study. Osteoporotic vertebral fractures strated and the maximum prevalence was recorded in represent a serious problem, which is due not only to their patients over 85 years of age (29.1%) (Fig. 1). According to high real prevalence and low detectability, but also to a sig- the social research program conducted by the US National nificant impact on the decrease in the quality of life [17]. Center for Health Statistics, National Health and Nutrition Studies conducted earlier in three cities of Russia (Moscow, Examination Survey, from 1988 to 1994, 1.3 and 1.6% Yekaterinburg, and Yaroslavl) showed that the prevalence of of men and 12.1 and 9.7% of women aged 75–84 years these fractures is 7.2% and higher in men and 7% and higher and 85 years and older, respectively, were surveyed and in women, but again at a younger age [18]. Nevertheless, the reported having osteoporosis; however, densitometry results of detection of vertebral fractures in the EVKALIPT detected this disease already in 6.4 and 13.7% of men and study (3.7%) still indicate their insufficient diagnostics in 32.5 and 50.5% of women in the corresponding age cat- patients over 65 years of age. At the same time, the vast egories [13]. Thus, in the Russian study EVKALIPT, we majority of them had fractures of the radial bone (Table 2). established a similar awareness (11.6%) about the presence This type of fracture (distal part of the forearm) is one of 1 3 Archives of Osteoporosis (2023) 18:30 Page 9 of 11 30 the most common fractures in a fall from standing height. mineral density, obviously develops at an earlier age than According to an epidemiological study in Russia, its fre- the main many GSs. However, osteoporosis is diagnosed quency was 426/100,000 of the population, exceeding the at an older age, when GSs already appear and are detected incidence of femoral fracture by 3–7 times in men and 4–8 (addiction in everyday life, various sensitivity disorders, times in women, and significantly prevailing in women. In frailty syndrome, malnutrition, signs of immobility, our study, the first fracture of the radial bone most often such as fecal incontinence, bedsores, and falls, as well as occurred at the age of 65–74 years, but a repeated fracture chronic pain). It should be noted that in patients of the of the same location was registered already at the age of age categories considered, significant hormonal changes 75–84 years, which is consistent with the data that the risk occur in the body, namely the levels of growth hormone, of a subsequent fracture after the initial fracture increases sex hormones, and insulin-like growth factor as well as by 1.6–4.3 times at any age [19]. their bioavailability (decreases). Such changes lead to However, it is noteworthy that in 594 (15.77%) patients impaired osteogenesis and increased bone resorption. A with a history of fracture in the subanalysis presented, significant contribution to the pathogenesis of bone aging osteoporosis was not diagnosed and, accordingly, no is due to vitamin D deficiency that increases with age treatment was prescribed. When analyzing data from 6 and is aggravated by such GSs as malnutrition. Such an European countries (France, Spain, Italy, Great Britain, association of GSs and osteoporosis arises possibly, among Sweden), 60–85% of women with a history of fracture other things, due to increased immune inflammation and also did not receive subsequent treatment for osteoporosis secretion of pro-inflammatory interleukins (IL-1, IL-6) and [20]. Our study revealed that only 12 (4.7%) patients TNF. Aged patients have decreased glomerular filtration received antiresorptive therapy, 1 (0.4%) patient received rate which exacerbates age-related vitamin D deficiency. bone anabolic therapy, and 9 (3.5%) patients received both All these changes initiate the progression of osteoporosis antiresorptive and bone-metabolic therapy; however, 91.4% in patients over 65 years of age [23, 24]. Thus, geriatric of patients still confirmed the prescription of vitamin D and syndromes are associated with the presence of osteoporosis calcium supplements. These data indicate insufficiently and its severity. The results of the association of most GSs complete treatment of osteoporosis. Similar results were and osteoporosis are consistent with the findings obtained obtained in Europe; thus, 71% of women with indications for in a study conducted at the Russian Gerontological anti-osteoporotic treatment did not receive this therapy [15]. Research and Clinical Center among patients of the These findings can be due to a number of factors, including geriatric therapy department, which revealed that patients the low awareness of doctors and patients about the need with osteoporosis had frailty syndrome, malnutrition, and for osteoporosis treatment, the need for long-term treatment physical inactivity significantly more often (p < 0.001) [25]. of osteoporosis, the high cost of drugs for the treatment So the geriatric status of older patients with osteoporosis of osteoporosis, and the large number of drugs taken for tends to be worse. other diseases. Thus, in the osteoporosis group, a greater It should be noted that weight loss and a decrease in number of patients were recorded who took 5 or more drugs. muscle mass/strength are associated with frailty syndrome Polypharmacy is a GS which is often cited as a potential and are signs of sarcopenia [26]. Sarcopenia is a progres- barrier to adherence to the regimen of drug intake, used to sive generalized skeletal muscle disorder associated with a treat osteoporosis, and is an independent negative factor in high risk of adverse outcomes, including falls, fractures, and long-term therapy [21]. It has been revealed that women physical disability as well as death. Sarcopenia and osteo- taking medications for other diseases were less adherent penia have common risk factors and pathogenesis and are to osteoporosis therapy, and those who used more than ten associated with myogenesis and osteogenesis. The combi- drugs had a 1.87-fold risk of being non-adherent compared nation of sarcopenia and osteoporosis/osteopenia is called to those who did not use medications [22]. sarcoosteopenia. In 2009, this term was first used in elderly Patients with osteoporosis have a high comorbidity, patients with a higher risk of falls, fractures, disability, and a burdened geriatric status [12]. Thus, in our study, the decrepitude [27]. In our study, muscle strength was assessed greatest number of GSs was revealed in patients with using carpal dynamometry (Table 4). In the osteoporosis osteoporosis, with the exception of orthostatic hypotension group, muscle strength was reduced in 73% of patients; in and hearing loss (Table 6). In addition, osteoporosis, being the same group, the SPPB score was lower (Table 4). Thus, associated with almost all GSs (OR 1.19–3.10), was not the decrease in these indicators in the osteoporosis group associated with orthostatic hypotension, hearing loss, and was due to osteosarcopenia. Age-related changes in the hor- cognitive impairment (Table 7). This could be explained by monal and metabolic status in combination with the majority the fact that patients over 65 years of age with osteoporosis of GSs and the probable development of osteosarcopenia, as frequently used hearing aids than patients without well as changes in the life status of a person with age, could osteoporosis (Table 5). Osteoporosis, as a change in bone explain the results of the multivariate analysis (Table 8). 1 3 30 Page 10 of 11 Archives of Osteoporosis (2023) 18:30 Machekhina Lubov V.—substantial contributions to conception and Conclusion design, acquisition of data, analysis and interpretation of data, and approval of the version to be published and all subsequent versions. Osteoporosis is a severe age-related disease that can lead Selezneva Elena V.—substantial contributions to conception and to poor outcomes. Geriatric syndromes are associated with design, acquisition of data, and analysis and interpretation of data. Ovcharova Lilia N.—substantial contributions to conception and the presence of osteoporosis and its severity; so the geriatric design acquisition of data and analysis and interpretation of data. status of older patients with osteoporosis tends to be worse. Kotovskaya Yulia V.—substantial contributions to conception and The association of osteoporosis with a large number of GSs design, or acquisition of data, analysis and interpretation of data, and aggravates the condition of these patients making treatment approval of the version to be published and all subsequent versions. Tkacheva Olga N.—substantial contributions to conception and difficult. Therefore, scheduled, early, and timely diagnosis design, acquisition of data, analysis and interpretation of data, and of osteoporosis (careful assessment of the history of falls, approval of the version to be published and all subsequent versions. fractures, and their localization, as well as changes in anthro- All authors read and approved the final manuscript. pometric parameters, namely reduced height) and GSs, as Data availability The data that support the findings of this study are well as development of an individual treatment plan to alle- available on request from the corresponding author [OnuchinaY.S.]. viate the condition of these patients, is of great clinical util- The data are not publicly available due to them containing information ity. “Treat the patient the way you would like to be treated” that could compromise research participant privacy/consent. is an ancient truth which is at the core of medicine. It is an obvious fact that important, new, and interesting conclusions Declarations were made in the EVKALIPT study, despite its complicated, Ethical approval and consent to participate All procedures performed time-consuming, and diverse nature. Success and efficiency in studies involving human participants were in accordance with the in the management are achieved only in a team approach to ethical standards of the institutional and/or national research commit- solving problems. Thus, it is necessary to adopt additional tee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Rus- programs at the state level to introduce information about sian Gerontology Research and Clinical Centre Ethics Committee (No. GSs and opportunities to work with elderly patients; timely 262). Informed consent was obtained from all individual participants (early) detection and correction of osteoporosis; and dis- included in the study. semination of information among medical workers, patients, and their relatives. Conflicts of interest None. Limitations of the study References 1. One of the disadvantages is the fact that the diagnosis of osteoporosis was revealed on the past medical history, 1. Beard JR, Officer A, de Carvalho IA et al (2016) The World report on ageing and health: a policy framework for healthy ageing. Lan- which limits us in comparison with other studies where cet 387(10033):2145–2154 DXA was performed. 2. Inouye SK, Studenski S, Tinetti ME, Kuchel GA (2007) Geriatric 2. The study focuses on 3 localizations of osteoporotic syndromes: clinical, research, and policy implications of a core fractures, which we believe are the most important geriatric concept. J Am Geriatr Soc 55:780–791 3. Rosso AL, Eaton CB, Wallace R, Gold R, Stefanick ML, Ockene and relevant. Other fractures are less often taken into JK et al (2013) Geriatric syndromes and incident disability in account by patients and doctors, and are more difficult older women: results from the women’s health initiative observa- to statistically analyze. tional study. J Am Geriatr Soc 61:371–379 4. Lesnyak OM, Baranova IA, Belova KYu, Gladkova EN, Evstign- eeva LP, Ershova OB, Karonova TL, Kochish AYu, Nikitinskaya OA, Skripnikova IA, Toroptsova NV, Aramisova RM (2018) Osteoporosis in the Russian Federation: epidemiology, medical, Author contribution Dudinskaya Ekaterina N.—substantial contri- social, and economic aspects of the problem (literature review). butions to conception and design, acquisition of data, analysis and Travmatologiya i ortopediya Rossii 24(1):155–167 interpretation of data, drafting the article or revising it critically for 5. Camacho PM, Petak SM, Binkley N et al (2020) American Asso- important intellectual content, and approval of the version to be pub- ciation of Clinical Endocrinologists/American College of Endo- lished and all subsequent versions. crinology Clinical Practice Guidelines for the Diagnosis and Treat- Vorobyeva Natalia M.—substantial contributions to conception and ment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract design, acquisition of data, analysis and interpretation of data, drafting 26(Suppl 1):1–46. https:// doi. org/ 10. 4158/ GL- 2020- 0524S UPPL the article or revising it critically for important intellectual content, and 6. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, approval of the version to be published and all subsequent versions. Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteo- Onuchina Julia S.—substantial contributions to conception and porosis in the European Union: medical management, epidemi- design, acquisition of data, analysis and interpretation of data, draft- ology and economic burden. A report prepared in collaboration ing the article or revising it critically for important intellectual content, with the International Osteoporosis Foundation (IOF) and the and approval of the version to be published and all subsequent versions. European Federation of Pharmaceutical Industry Associations 1 3 Archives of Osteoporosis (2023) 18:30 Page 11 of 11 30 (EFPIA). Arch Osteoporos  8(1):136. https:// doi. or g/ 10. 1007/ morphometric analysis. Osteoporoz i osteopatii [Osteoporosis and s11657- 013- 0136-1 and Bone Diseases] 2:2–6 7. Vorobyeva NM, Tkacheva ON, Kotovskaya Yu V et al (2021) 19. Hodsman AB, Leslie WD, Tsang JF et al (2008) 10-year probability Russian epidemiological study EVKALIPT: protocol and basic of recurrent fractures following wrist and other osteoporotic fractures characteristics of participants. Russ J Geriatr Med (1):35–43 in a large clinical cohort: an analysis from the Manitoba Bone Density 8. Tkacheva ON, Runikhina NK, Ostapenko VS et al (2018) Preva- Program. Arch Intern Med 168(20):2261–2267 lence of geriatric syndromes among people aged 65 years and older 20. Borgström F et al (2020) Fragility fractures in Europe : burden, at four community clinics in Moscow. Clin Interv Aging 251–259 management and opportunities. Arch Osteoporos 15:59 9. Tkacheva ON, Runikhina NK, Ostapenko VS et al (2017) Vali- 21. Weiss TW, Henderson SC, McHorney CA, Cramer JA (2007) Persis- dation of the questionnaire for screening frailty. Adv Gerontol tence across weekly and monthly bisphosphonates: analysis of US retail 30(2):236–242 pharmacy prescription refills. Curr Med Res Opin 23(9):2193–2203 10. Tkacheva N, Yu V, Kotovskaya NK, Runikhina EV et al (2020) 22. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Clinical recommendations frailty syndrome. Russ J Geriatr Med Determinants of non-compliance with bisphosphonates in (1):11–46 women with postmenopausal osteoporosis. Curr Med Res Opin 11. Tkacheva ON, Kotovskaya YV, Runikhina NK et al (2020) Clini- 24(5):1337–1344 cal guidelines frailty. Part 2. Russ J Geriatr Med (2):115–130. 23. Soysal P, Stubbs B, Lucato P et al (2016) Inflammation and frailty https:// doi. org/ 10. 37586/ 2686- 8636-2- 2020- 115- 130 in the elderly: a systematic review and meta-analysis. Ageing Res 12. Aspray TJ, Hill TR (2019) Osteoporosis and the ageing skeleton. Rev 31:1–8. https:// doi. org/ 10. 1016/j. arr. 2016. 08. 006 Subcell Biochem 91:453–476. https:// doi. org/ 10. 1007/ 978- 981- 24. Ma L, Sha G, Zhang Y, Li Y (2018) Elevated serum IL-6 and 13- 3681-2_ 16 adiponectin levels are associated with frailty and physical function 13. Vondracek SF, Linnebur SA (2009) Diagnosis and management in Chinese older adults. Clin Interv Aging 13:2013–2020. https:// of osteoporosis in the older senior. Clin Interv Aging 4:121–136doi. org/ 10. 2147/ CIA. S1809 34 14. Sarafrazi N, Wambogo EA, Shepherd JA (2021) Osteoporosis or 25. Khovasova NO, Naumov AV, Tkacheva ON, Dudinskaya EN low bone mass in older adults: United States, 2017–2018. NCHS (2021) Characteristics of geriatric and somatic status in patients Data Brief (405):1–8 with osteoporosis. Problemy endokrinologii, No 67(3):45–54 15. Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lor- 26. Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet entzon M, McCloskey EV, Willers C, Borgström F (2021) SCOPE 393(10191):2636–2646 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos 27. Binkley N, Buehring B (2009) Beyond FRAX: It’s time to con- 16(1):82. https:// doi. org/ 10. 1007/ s11657- 020- 00871-9 sider ‘sarco-osteopenia.’ J Clin Densitom 12(4):413–416 16. Lesnyak OM, Ershova OB, Belova KYu, Gladkova EN et al (2014) Epidemiology of osteoporotic fractures in the Russian Federation Publisher's note Springer Nature remains neutral with regard to and the Russian FRAX model. Osteoporoz i osteopatii, No 3:3–8 jurisdictional claims in published maps and institutional affiliations. 17. Johansson L, Sundh D, Nilsson M et al (2018) Vertebral fractures and their association with health-related quality of life, back pain Springer Nature or its licensor (e.g. a society or other partner) holds and physical function in older women. Osteoporos Int 29(1):89–99 exclusive rights to this article under a publishing agreement with the 18. Evstigneeva LP,  Piven AI (2001) Epidemiology of osteoporo- author(s) or other rightsholder(s); author self-archiving of the accepted tic vertebral fractures among population sample of inhabitants manuscript version of this article is solely governed by the terms of of the Yekaterinburg city of 50 years and older based on X-ray such publishing agreement and applicable law. Authors and Affiliations 1 2 1,3 1 Ekaterina N. Dudinskaya  · Natalia M. Vorobyeva  · Julia S. Onuchina  · Lubov V. Machekhina  · 4 4 5 5,6 Elena V. Selezneva  · Lilia N. Ovcharova  · Yulia V. Kotovskaya  · Olga N. Tkacheva Ekaterina N. Dudinskaya Laboratory of Cardiovascular Aging, Russian Gerontology katharina.gin@gmail.com Research and Clinical Centre, Pirogov Russian National Research Medical University, Moscow, Russia Natalia M. Vorobyeva vorobyeva_nm@rgnkc.ru Department of Aging Diseases, Faculty of Additional Professional Education, Russian Gerontology Research Lubov V. Machekhina and Clinical Centre, Pirogov Russian National Research mlv66@list.ru Medical University, Moscow, Russia Yulia V. Kotovskaya Institute for Social Policy, National Research University kotovskaya_yv@rgnkc.ru “Higher School of Economics”, Moscow, Russia Olga N. Tkacheva Russian Gerontology Research and Clinical Centre, Pirogov tkacheva@rgnkc.ru Russian National Research Medical University, Moscow, Russia Age-Related Endocrine and Metabolic Disorders Laboratory, Russian Gerontology Research and Clinical Centre, Pirogov Russian Academy of Sciences, Moscow, Russia Russian National Research Medical University, Moscow, Russia 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Osteoporosis Springer Journals

The association of osteoporosis and geriatric syndromes in the elderly: data from the Russian epidemiological study EVKALIPT

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1862-3522
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10.1007/s11657-023-01217-x
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Abstract

Summary Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients. Purpose To analyze associations of osteoporosis with geriatric syndromes in patients aged 65 years and older in the Rus- sian Federation. Methods A total of 4308 patients (30% men) aged 65–107 years were examined and distributed into 3 age groups (65– 74 years, 75–84 years, and 85 years and older). All patients underwent a comprehensive geriatric assessment. In the “Falls and risk of falls” module, the number and circumstances of falls over the previous year were analyzed, as well as the history of fractures. The presence of osteoporosis was determined based on medical records. Physical examination included anthro- pometric measurements and standard enquiry, short physical performance battery (SPPB), dynamometry, measurement of gait velocity, Mini-Cog test, and orthostatic test. Results A total of 507 patients (11.8%) had evidence of osteoporosis; indications of low-energy fractures in history were recorded in 739 (17.3%) patients. Patients with osteoporosis were older, shorter, and predominantly women; had a lower body weight and a higher Charlson comorbidity index; and took more drugs. Patients with osteoporosis had lower gait velocity, hand grip strength, Barthel index value, and scores of the Lawton instrumental activities of daily living scale, the MNA (Mini Nutritional Assessment) short-form, and the SPPB. Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Conclusions Osteoporosis is associated with almost all GSs. The association of osteoporosis with advanced GSs aggravates the condition of these patients. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients: early detection and correction of osteoporosis. Keywords Older age · Osteoporosis · Fractures · Geriatric syndromes Introduction the middle of the twenty-first century (2050), it will be at least 27% [1]. As the population rapidly ages, interest in The global population is aging, and the proportion of the age-related diseases and geriatric syndromes (GSs) also elderly people is registered in on the rise worldwide. In the rises. GS is a multifactorial age-associated clinical condi- middle of the twentieth century, the proportion of people tion that worsens the quality of life and increases the risk of over 65 years of age was 7.7% of the world’s population; adverse outcomes (death, dependence on external assistance, over the first 20 years of the next century, the proportion repeated hospitalizations, and need for long-term care) and of people of this age increased to 19% (2019 data), and by functional disorders [2, 3]. Age-associated diseases and GSs include disease such as osteoporosis. The term “osteopo- rosis” was used in France in the early nineteenth century * Julia S. Onuchina and implied bone pathology. Osteoporosis is classified by onuchina90@list.ru WHO as one of the five most significant human diseases Extended author information available on the last page of the article Vol.:(0123456789) 1 3 30 Page 2 of 11 Archives of Osteoporosis (2023) 18:30 alongside infarction, stroke, cancer, and sudden death. In the number of participants and their distribution by age groups mid-2000s, 33.8% of women and 26.9% of men in Russia in individual regions did not always correspond to the over the age of 50 have osteoporosis. Extrapolation of the planned. The majority (60%) of the participants were exam- entire population of the Russian Federation revealed 14 mil- ined in a clinic, every fifth in a hospital (20%) or at home lion patients, which is about 10% of the population [4]. At (19%), and 1% in nursing homes. present, the social significance of osteoporosis is recorded, This data is a part of a large epidemiological study of determined by its consequences, namely low-trauma frac- EVKALIPT conducted in the Russian Federation. Russian tures of the vertebral bodies and bones of the peripheral EVKALIPT study protocol and basic characteristics of par- skeleton, leading to high healthcare burden as well as sig- ticipants are summarized in the article [7]. nificant impairments such as disability and mortality [5 , 6]. All patients underwent a comprehensive geriatric assess- At the same time, the exact prevalence of osteoporosis is ment (CGA) in two stages: (1) survey based on a specially unknown due to the fact that in most cases, only fractures designed questionnaire and (2) physical examination. This of the proximal femur are recorded, including in elderly was performed simultaneously by a geriatrician and a geri- patients. atric nurse at the patient’s residence (in a hospital, clinic, In Russia, data on osteoporosis is old, and generally residential institution/assisted-living facility, or at home). relates to particular regions, that is why it needs to provide The questionnaire included the “Socio-economic sta- new investigation. tus,” “Occupational history,” “Risk factors for chronic non- In 2018, the EVKALIPT (Epidemiological study of the communicable diseases,” “Chronic non-communicable prevalence of GSs and age-associated diseases in the elderly diseases,” “Drug therapy,” “Obstetrics and gynecological patients in regions of the Russian Federation with different history,” “Falls and risk of falls,” “Chronic pain,” “Sensory climatic, economic, and demographic characteristics) study deficits,” “Oral health,” “Urine and fecal incontinence,” among patients aged 65 years and older was started, aimed “Use of aids,” “Laboratory examination results,” and a at obtaining the prevalence of age-associated diseases, frailty number of standardized scales: screening scale “Age is not syndrome, other GSs, osteoporosis, and fractures, as well as a problem,” the Geriatric Depression Scale GDS-15, Basic analysis of their contribution to parameters of general health Functional Activity Scale (Barthel Index), Lawton Instru- and functional status in Russia. The study was performed mental Activities of Daily Living Scale, MNA (Mini Nutri- from 2018 to 2020 in 11 regions of Russia at the initiative tional Assessment) short-form, Charlson comorbidity index, of the Russian Association of Gerontologists and Geriatri- and Visual Analog Scale (VAS) for self-assessment of qual- cians and the Russian Gerontological Research and Clinical ity of life, health status, and intensity of pain syndrome at Center in cooperation with the National Research University the time of the examination and during their stay. Higher School of Economics. For screening frailty in daily practice in Russia, they developed the questionnaire “Vozrast ne pomekha” (VNP), which translates into English as “Age is not a hindrance.” Materials and methods The study questionnaire was composed of seven dichoto- mous items for evaluation of the following characteris- In a cross-sectional analytical epidemiological study, tics: weight loss (“Did you lose 5 kg or more in the past EVKALIPT included patients aged from 65 to 107 years 6  months?”), impaired vision or hearing (“Do you have (mean age 78 ± 8 years), from April 2018 to October 2019, any restrictions in daily living due to decreased vision or who live in 11 Russian regions (Republics of Bashkorto- hearing?”), fall-related injuries (“Have you had any injury- stan, Dagestan, and Chuvashia; Voronezh and the Voronezh related falls during the last year?”), mood disorder (“Have region; Moscow; Saratov; St. Petersburg and the Leningrad you felt depressed, sad or anxious over the past weeks?”), region; Ivanovo, Ryazan, Samara, and Smolensk region). cognitive impairment (“Do you have problems with mem- Inclusion criteria were age of 65 years or older and writ- ory, comprehension, orientation or ability to plan?”), urinary ten voluntary informed consent to participate in the study. incontinence (“Do you have urinary incontinence?”), and In accordance with the protocol, participants were dis- difficulty walking (“Do you have any difficulty walking at tributed into three age groups (65–74 years, 75–84 years, home or on the street up to a distance of 100 m, or climbing and ≥ 85 years). a flight of stairs?”). One point was recorded for each positive Initially, it was planned to include 600 people from each answer, so the total score ranged from 0 to 7 [8]. A score region (200 participants in each age group) in the study. of ≥ 5 indicates a high probability of frailty syndrome. This However, only a small number of participants were included questionnaire underwent a validation process, and the results in this way. Most of the participants were recruited on the of that process were published previously and are presented basis of seeking medical care, i.e., planned inpatient treat- in abridged form here [9]. This scale was added in clinical ment in geriatric departments/hospitals, so the actual total guidelines on frailty in Russia [10]. 1 3 Archives of Osteoporosis (2023) 18:30 Page 3 of 11 30 The physical examination included (1) short physical per- (4) malnutrition, (5) orthostatic hypotension, (6) urinary formance battery tests (SPPB), (2) dynamometry, (3) meas- incontinence, (7) fecal incontinence, (8) functional disor- urement of gait velocity, (4) Mini-Cog test, (5) measurement ders, (9) loss of autonomy, (10) falls (for the previous year), of height and body weight, calculation of body mass index (11) vision deficit, (12) hearing loss, (13) sensory deficit (BMI), (6) measurement of blood pressure (BP) and heart (any), (14) chronic pain syndrome, and (15) bedsores. rate (HR), and (7) orthostatic test. Osteoporosis was diagnosed if in medical history is reg- All tests, scales, and questionnaires used in the study istered a low-trauma (i.e., fragility) fracture of major bones (with the exception of the Charlson comorbidity index) are (vertebral or proximal femur fracture or multiple fracture), in the Russian clinical guidelines “Frailty syndrome” [10, increased fracture risk using FRAX® (Fracture Risk Assess- 11]. The detailed study protocol and baseline characteristics ment Tool) Russian-specific threshold, or if patient had of the participants have been presented in our previously results of Bone Densitometry with T-score − 2.5 or below published article [7]. in the lumbar spine, femoral neck, total proximal femur, The “Falls and risk of falls” module considered the num- or patient’s information. A fragility fracture was mean as ber and circumstances of falls over the previous year, as a fracture sustained from low-energy trauma, such as a fall well as the history of fractures (fractures of the vertebrae, from standing height or less, that would not have occurred in femur, and radius when falling from standing height and healthy bone, excepting fractures of the skull, face, fingers, their number, surgical treatment for fractures of the verte- and toes. brae, the need for care due to fracture, fracture of the femoral neck in parents). Characteristics of the participants The physician assessed cognitive function and completed the modules “Chronic non-communicable diseases,” “Drug The study included 4308 patients (30% men) aged therapy,” “Obstetrics and gynecological history,” and “Labo- 65–107 years (Table 1). The majority (60%) of participants ratory examination results.” The nurse completed all other were examined in a polyclinic setting, 20% examined in a modules and the physical examination. hospital, 19% at home, and 1% in residential institutions/ The presence of the following GSs was determined: (1) assisted-living facilities. Among those examined, over- frailty syndrome, (2) cognitive impairment, (3) depression, weight patients prevailed (41%), while the proportion of Table 1 Demographic, anthropometric, and clinical characteristics of patients aged 65 years and older (values in bold indicates statistical difference) Parameter All patients (n = 4308) Age groups p for trend 65–74 years (n = 1583) 75–84 years (n = 1519) ≥ 85 years (n = 1206) Age, years (M ± SD) 78.3 ± 8.4 69.1 ± 2.6 79.4 ± 2.5 88.9 ± 3.3 - Male gender, % 29.7 31.9 27.3 29.9 0.020 Height, m (M ± SD) 1.63 ± 0.09 1.64 ± 0.08 1.62 ± 0.08 1.61 ± 0.09 < 0.001 Weight, kg (M ± SD) 73.9 ± 14.3 78.3 ± 14.5 73.3 ± 13.3 68.9 ± 13.2 < 0.001 Body mass index, kg/m 27.9 ± 5.0 29.0 ± 5.2 27.9 ± 4.9 26.6 ± 4.4 < 0.001 (M ± SD) Body mass, %   Deficit 1.3 1.0 0.9 2.2 0.007   Norm 27.6 21.3 28.4 34.7 < 0.001   Excess 40.9 41.1 39.6 42.2 0.414   Obesity 30.2 36.6 31.1 21.0 < 0.001 Degrees of obesity, % (n = 1264)   I 72.2 66.8 75.0 78.8 0.001   II 21.6 24.2 20.2 18.4 0.118   III 6.3 9.0 4.8 2.8 0.001 Systolic blood pressure, mm Hg 136.1 ± 16.5 136.4 ± 16.6 136.0 ± 16.0 135.8 ± 17.0 0.819 (M ± SD) Diastolic blood pressure, mm Hg 80.2 ± 9.5 81.6 ± 9.5 80.1 ± 9.2 78.5 ± 9.7 < 0.001 (M ± SD) Pulse blood pressure, mm Hg 55.9 ± 13.0 54.8 ± 12.5 55.8 ± 12.4 57.3 ± 14.0 < 0.001 (M ± SD) Heart rate, beats/min (M ± SD) 72.7 ± 8.6 72.6 ± 8.3 73.0 ± 9.1 72.3 ± 8.3 0.111 1 3 30 Page 4 of 11 Archives of Osteoporosis (2023) 18:30 patients with obesity and normal body weight was similar 292 (39.6%) had a fracture of the proximal femur, 464 (63%) (30% and 28%), and 1.3% of participants were underweight had a fracture of the radial bone, and 158 (21.5%) had a (Table 1). Among patients with obesity, the majority of par- fracture of the vertebrae. We noted a decrease in the propor- ticipants were obesity type I. With an increase in age, there tion of patients undergoing surgical treatment for vertebral is a decrease in height, body weight, BMI, the proportion fractures alongside (Table 2); there were no differences in of obese patients, and the severity of obesity, as well as an other parameters across the age groups. increase in the proportion of patients with normal weight. Among patients without documented osteoporosis The proportion of overweight patients was identical in all (n = 3788), 594 (15.7%) presented with low-energy frac- age groups. The mean values of systolic and diastolic BP tures in history: thus, these patients also had osteoporosis not and heart rate were within the normal range in all patients; diagnosed in a timely manner. For further analysis, patients however, diastolic BP also decreased with age and pulse with documented osteoporosis and with a history of frac- BP increased with similar identical values of systolic BP tures were combined into one group (group with osteoporo- and HR. sis; n = 1101). The osteoporosis group accounted for 25.6% of all patients. Comparison group consisted of patients Statistical data analysis without documented osteoporosis or history of low-energy fractures (group without osteoporosis; n = 3168). Increased The study was performed using IBM® SPSS® Statistics prevalence of osteoporosis increased significantly with age version 23.0 (SPSS Inc., USA). The type of distribution of (Fig. 1). quantitative variables was analyzed using the one-sample Patients with osteoporosis were older, shorter, and Kolmogorov–Smirnov test. Results of parametric data were predominantly females; had a lower BMI and a higher presented as M ± SD, where M is the mean, and SD is the Charlson comorbidity index; and took much more drugs standard deviation; while that of non-parametric data, the (Table 3). results are presented as Me (25%; 75%), where Me is the According to the results of CGA, patients with osteo- median, and 25% and 75% are the 25th and 75th percentiles. porosis had lower gait velocity, hand grip strength, Bar- For clarity, some variables are presented simultaneously as thel index value, Lawton Instrumental Activities of Daily Me (25%; 75%) and M ± SD. For intergroup comparisons, Living Scale scores, MNA (Mini Nutritional Assessment) the Mann–Whitney, Kruskal–Wallis, and Pearson’s χ tests, short-form, and SPPB. However, they presented with as well as Fisher’s two-tailed exact test, were used. Relation- higher Geriatric Depression Scale and the screening scale ships between variables were assessed using binary logistic “Age is not a problem” scores. Patients with osteoporosis regression with the odds ratio (OR) and 95% confidence presented with lower quality of life and health status, and interval (CI). One-way and multivariate regression analy- higher intensity of pain syndrome at the time of examina- ses were performed after adjusting for age and gender. We tion as well as 7 days prior to examination (Table 4). analyzed the variables using the direct stepwise selection Patients with osteoporosis used assistive products more method of multivariate analysis. Differences were consid- often (with the exception of spectacles/lenses which, how- ered significant at a two-tailed p < 0.05. ever, they tended to use more frequently), and their number per patient was significantly higher than in those without osteoporosis (Table 5). Results Patients with osteoporosis showed a higher incidence of all GSs, except for orthostatic hypotension and hearing The presence of osteoporosis was determined based on past loss (Table 6); and the most common GSs were chronic medical records. Information related to chronic disease was pain syndrome (95%), basic dependence in everyday life present for 4295 (99.7%) participants, and 507 (11.8%) were (71%), frailty syndrome (68%), cognitive impairment osteoporotic. Information about drugs was known in 501 (65%), instrumental dependence in everyday life (58%), (98.8%) patients with osteoporosis, and almost half (49.1%) probable depression (57%), and urinary incontinence of them were not on treatment of osteoporosis. Among all (57%). patients treated with drugs, the majority (91.4%) were on A one-way regression analysis adjusted for age and calcium and vitamin D supplements, 12 (4.7%) patients gender. GSs were considered as a dependent variable, received antiresorptive therapy, 1 (0.4%) patient received and the presence of osteoporosis, age (as an extended bone anabolic therapy, and 9 (3.5%) patients received antire- variable), and gender were independent variables. Results sorptive and bone-metabolic therapy. demonstrated that osteoporosis is associated with almost Information related to the history of fragility fractures all GSs, with the exception of orthostatic hypotension, was available in 4275 (99.2%) participants. A history of fra- hearing loss, and cognitive impairment (OR from 1.19 to gility fractures was recorded in 739 (17.3%) patients, and 3.10) (Table 7). 1 3 Archives of Osteoporosis (2023) 18:30 Page 5 of 11 30 Table 2 Incidence of low-energy fractures in history in patients aged 65 years or older (values in bold indicates statistical difference) Parameter All patients Age groups p for trend (n = 4308) 65–74 years 75–84 years ≥ 85 years (n = 1583) (n = 1519) (n = 1206) History of low-energy fractures, % 17.3 15.9 17.7 18.6 0.148 Proximal femur fractures due to a fall from standing height in history, % 6.8 6.0 6.5 8.2 0.057 Surgical treatment for proximal femur fracture in history, % (n = 290) 57.6 58.1 60.6 54.1 0.647 Fractures of the radial bone due to a fall from standing height in history, % 10.8 9.8 11.5 11.3 0.257 Number of fractures of the radial bone due to a fall from standing height in 0.022 history, % (n = 432) 1 80.8 87.5 75.0 80.5 2 or more 19.2 12.5 25.0 19.5 History of vertebral fractures due to a fall from standinsg height, % 3.7 3.2 3.7 4.3 0.289 Number of vertebral fractures due to a fall from standing height in history, % 0.562 (n = 72) 1 86.1 91.3 80.8 87.0 2 or more 13.9 8.7 19.2 13.0 Surgical treatment for a vertebral fracture in history, % (n = 139) 33.8 46.5 34.7 21.3 0.040 Need for care due to a fracture, % (n = 154) 0.227 No 23.4 33.3 21.8 15.7 Yes, cared for by a nurse 12.3 8.3 10.9 17.6 Yes, cared for by relatives 64.3 58.3 67.3 66.7 Proximal fracture in parents, % 3.4 3.6 3.4 3.1 0.817 p for trend < 0.001 Fig. 1 Prevalence of osteoporo- 29.1 р для тренда <0,001 sis in patients aged 65 years and older according to age groups 26.2 (patients with documented osteoporosis and with a history of fractures) 22.9 Years 65-74 года 75-84 года ≥85 лет Years Years Multivariate regression analysis (adjusted for age presence of osteoporosis was considered a dependent and gender) included 12 GSs with a significance level variable, and GSs, age (as an extended variable), and of p < 0.05 based on the results of one-way analysis; the gender were considered independent variables. Multivariate 1 3 % patients examined % обследуемых 30 Page 6 of 11 Archives of Osteoporosis (2023) 18:30 Table 3 Demographic, Indicator Osteoporosis No osteoporosis p anthropometric, and (n = 1101) (n = 3168) clinical characteristics according to the presence Age, years (M ± SD) 79.2 ± 8.4 78.0 ± 8.4 < 0.001 or absence of osteoporosis Female gender, % 81.7 66.4 < 0.001 in patients aged ≥ 65 years Height, m (M ± SD) 1.61 ± 0.08 1.63 ± 0.09 < 0.001 (n = 4269) (values in bold indicates statistical difference) Weight, kg (M ± SD) 72.1 ± 15.2 74.5 ± 13.9 < 0.001 Body mass index, kg/m (M ± SD) 27.7 ± 5.2 28.0 ± 4.9 0.026 Body mass, %   Deficit 1.6 1.2 0.374   Norm 29.1 27.0 0.192   Excess 41.4 40.7 0.689   Obesity 27.9 31.0 0.055 Degrees of obesity, % (n = 1256)  I 68.5 73.3 0.105   II 24.2 20.9 0.229   III 7.4 5.8 0.337 Charlson comorbidity index [Me (25%; 75%)] 5 (4; 7) 4 (3; 6) < 0.001 Charlson comorbidity index ≥ 5 points, % 60.0 49.0 < 0.001 Number of drugs 6 (4; 8) 5 (3; 7) < 0.001 Number of drugs ≥ 5, % 68.2 56.0 < 0.001 Table 4 Results of CGA according to the presence or absence of osteoporosis in patients aged ≥ 65  years (n = 4269)  (values in bold indicates statistical difference) Indicator Osteoporosis (n = 1101) No osteoporosis (n = 3168) p Screening scale “age is not a problem.” points* 3 (2; 4) 2 (1; 4) < 0.001 SPPB. points * 5 (2; 8) 6 (3; 9) < 0.001 Hand grip strength. kg* 20 (15; 26) 22 (16; 30) < 0.001 15 (10; 20) 16 (11; 22) < 0.001 Decrease in hand grip strength. % 73.7 69.8 0.022 Gait velocity. m/s* 0.57 (0.44; 0.82) 0.64 (0.47; 0.83) 0.026 Decrease in gait velocity. % 57.7 55.4 0.220 Basic activity scale in everyday life (Barthel index). points 95 (80; 100) 95 (90; 100) < 0.001   Me (25%; 75%) 85.3 ± 19.7 89.7 ± 17.0   M ± SD Lawton Instrumental Activities of Daily Living Scale. points 7 (5; 8) 7 (5; 8) < 0.001   Me (25%; 75%) 6.0 ± 2.2 6.3 ± 2.1   M ± SD MNA (Mini Nutritional Assessment) short-form (screening part). points 12 (10; 13) 12 (11; 13) < 0.001   Me (25%; 75%) 11.1 ± 2.2 11.8 ± 2.1   M ± SD Mini-cog test. points* 3 (2; 4) 3 (2; 4) 0.283 Geriatric depression scale points* 5 (3; 9) 4 (2; 7) < 0.001 Self-assessment of the quality of life according to VAS. points* 6 (5; 8) 7 (5; 8) < 0.001 Self-assessment of health status according to VAS. points* 5 (4; 7) 6 (5; 7) < 0.001 Self-assessment of pain at the time of examination according to VAS. points* 4 (1; 5) 3 (0; 5) < 0.001 Self-assessment of pain for the last week according to VAS. points* 5 (3; 7) 4 (1; 6) < 0.001 Results are presented as Me (25%; 75%) analysis revealed that five of them were independently in men (Table 8). The order of variables inclusion in the associated with osteoporosis and the likelihood of the model was as follows: falls in the previous year, female occurrence of osteoporosis was multiplied 1.2–2.5 times, gender, chronic pain syndrome, malnutrition, urinary and in women, the risk of osteoporosis is 84% higher than incontinence, and probable depression. 1 3 Archives of Osteoporosis (2023) 18:30 Page 7 of 11 30 Table 5 Frequency of use of assistive products according in relation to the occurrence of osteoporosis in patients aged ≥ 65 years (values in bold indicates statistical difference) Indicator Osteoporosis No osteoporosis p (n = 1101) (n = 3168) Use of aids, % 95.7 91.5 < 0.001 Number of aids <   Me (25%; 75%) 2 (2; 4) 2 (1; 3) 0.001   M ± SD 2.8 ± 1.6 2.1 ± 1.3 Spectacles/lenses, % 81.1 78.8 0.097 Hearing aid, % 8.7 6.8 0.040 Dentures, % 65.3 57.9 < 0.001 Cane, % 39.3 30.4 < 0.001 Crutches, % 3.6 2.0 0.002 Walkers, % 5.6 3.4 0.001 Wheel-chair, % 2.9 1.5 0.002 Orthopedic shoes, % 10.4 3.2 < 0.001 Orthopedic insoles, % 19.4 6.9 < 0.001 Spinal brace, % 9.9 2.9 < 0.001 Incontinence pads, % 19.6 11.8 < 0.001 Diapers/underpads, % 8.9 4.8 < 0.001 Assistive devices to facilitate mobility (cane, crutches, walkers, wheel-chair), % 44.1 33.4 < 0.001 Absorbent underwear for urinary/fecal incontinence (incontinence pads, diapers, 24.2 14.6 < 0.001 underpads), % Table 6 Incidence of geriatric Indicator Osteoporosis No osteoporosis p syndromes in relation to (n = 1101) (n = 3168) osteoporosis in patients aged ≥ 65 years (values in bold Chronic pain syndrome 95.1 84.5 < 0.001 indicates statistical difference) Basic dependence in everyday life 70.8 57.9 < 0.001 Instrumental dependence in everyday life 57.9 53.0 0.005 Frailty syndrome 68.0 60.8 < 0.001 Cognitive impairments 65.0 59.5 0.003 Probable depression 57.2 45.0 < 0.001 Urinary incontinence 57.3 41.1 < 0.001 Falls over the previous year 45.4 25.1 < 0.001 Sensory deficit (any) 18.2 14.5 0.004 Hearing loss 13.1 11.4 0.145 Vision deficit 6.8 4.5 0.002 Malnutrition 10.0 4.5 < 0.001 Orthostatic hypotension 8.1 7.9 0.845 Fecal incontinence 7.6 3.9 < 0.001 Bedsores 3.5 1.9 0.002 osteoporosis; however, it was not diagnosed in time. For Discussion further analysis, these patients were combined into one group with patients with registered osteoporosis (osteo- The presented subanalysis of data of the Russian epide- porosis group: n = 1101). Consequently, the prevalence of miological study EVKALIPT reveals that the prevalence osteoporosis in patients aged 65 years and older increases of osteoporosis in patients based on the survey was 11.8% to 25.6% with a predominance in women. Most guide- (n = 507). In addition, a group of patients with a his- lines and publications include information obtained in tory of low-energy fractures (n = 594; 15.7%) was iden- the early 2000s based on the results of a cluster cross- tified according to modern criteria, and also who had sectional study in a random sample of one of the districts 1 3 30 Page 8 of 11 Archives of Osteoporosis (2023) 18:30 Table 7 Association between osteoporosis and geriatric syndromes in of osteoporosis. The lack of information about instrumen- patients aged ≥ 65 years (one-way regression analysis as adjusted for age tal examination, and in particular densitometry, limits our and gender) (n = 4269 (values in bold indicates statistical difference) data obtained. In 2017–2018, in the USA, the prevalence Geriatric syndromes OR 95% CI p of osteoporosis in patients over 65 years old was studied based on instrumental data alone (low BMD according to Instrumental dependence in everyday 1.19 1.02–1.39 0.027 densitometry results), and it amounted to 17.7% [14]. In a life European study, among patients of all ages with osteopo- Sensory deficit (any) 1.22 1.00–1.48 0.047 rosis diagnosed based on a decrease in BMD in the femur, Frailty syndrome 1.22 1.04–1.42 0.013 the overall prevalence was 5.6% [15]. Vision deficit 1.44 1.06–1.94 0.018 According to Russian experts in the field of epidemiol- Probable depression 1.52 1.32–1.75 < 0.001 ogy, it has been established that the prevalence of osteopo- Basic dependence in everyday life 1.53 1.31–1.80 < 0.001 rosis in women in the Russian Federation is comparable to Urinary incontinence 1.66 1.43–1.92 < 0.001 global data, and Russian women are of average risk of osteo- Fecal incontinence 1.94 1.45–2.60 < 0.001 porosis on a pair with residents of North America and West- Bedsores 1.97 1.29–3.01 0.002 ern Europe, and in Russian men, it exceeds the prevalence Malnutrition 2.28 1.75–2.97 < 0.001 of osteoporosis in North America and Western Europe [4]. Falls over the previous year 2.28 1.97–2.64 < 0.001 In the EVKALIPT study, women obviously predominated Chronic pain syndrome 3.10 2.32–4.16 < 0.001 in the osteoporosis group among patients aged 65 years and Dependent variable: geriatric syndromes older (Table 3). Thus, in general, the prevalence of osteo- porosis in Russia is comparable to that in other countries. The social and medical significance of osteoporosis is Table 8 Associations between osteoporosis and geriatric syndromes in determined by the fractures caused by it [5]. In the EVKA- patients aged ≥ 65  years (multivariate regression analysis as adjusted for age and gender) LIPT study, 17% of patients had a history of low-energy fractures (Table 2). According to localization, fractures of Predictors OR 95% CI p the radial bone in the history prevailed (10.8%), proximal Female gender 1.84 1.54–2.20 < 0.001 femur fractures were less common (6.8%), and fractures of Probable depression 1.19 1.02–1.38 0.027 the vertebrae due to a fall from standing height in the his- Urinary incontinence 1.37 1.18–1.59 < 0.001 tory rarely occurred (3.7%) (Table 2). Fractures of the radial Malnutrition 1.91 1.45–2.52 < 0.001 bone were more common in patients aged 75–84 years, and Falls over the previous year 1.94 1.67–2.25 < 0.001 fractures of the proximal femur and vertebrae were regis- Chronic pain syndrome 2.46 1.83–3.32 < 0.001 tered more often in patients older than 85 years. At the age Dependent variable: osteoporosis of 50 years, the probability of fracture of the proximal femur during the subsequent life in the Russian Federation is 4% for men and 7% for women. In 2010, the number of fracture of Moscow, when osteoporosis was diagnosed in patients cases of the proximal femur in Russia was 112,000 cases; by aged 50 years and older based on changes in DXA densi- 2035, due to increased life expectancy alone, it will increase tometry in spine and/or proximal femur, and was detected by 36% in men and 43% in women, and will amount to 159 in 33.8% of women and 26.9% of men [4]. However, we thousand cases per year [16]. According to available statis- examined the indices of patients 15 years younger in this tics, the prevalence of bone fractures in Russia is 18.6 cases study. The prevalence of osteoporosis is known to increase per 1000 adult population, or 21.5% [4], which is somewhat with age [12]. In our study, this trend was also demon- higher than in our study. Osteoporotic vertebral fractures strated and the maximum prevalence was recorded in represent a serious problem, which is due not only to their patients over 85 years of age (29.1%) (Fig. 1). According to high real prevalence and low detectability, but also to a sig- the social research program conducted by the US National nificant impact on the decrease in the quality of life [17]. Center for Health Statistics, National Health and Nutrition Studies conducted earlier in three cities of Russia (Moscow, Examination Survey, from 1988 to 1994, 1.3 and 1.6% Yekaterinburg, and Yaroslavl) showed that the prevalence of of men and 12.1 and 9.7% of women aged 75–84 years these fractures is 7.2% and higher in men and 7% and higher and 85 years and older, respectively, were surveyed and in women, but again at a younger age [18]. Nevertheless, the reported having osteoporosis; however, densitometry results of detection of vertebral fractures in the EVKALIPT detected this disease already in 6.4 and 13.7% of men and study (3.7%) still indicate their insufficient diagnostics in 32.5 and 50.5% of women in the corresponding age cat- patients over 65 years of age. At the same time, the vast egories [13]. Thus, in the Russian study EVKALIPT, we majority of them had fractures of the radial bone (Table 2). established a similar awareness (11.6%) about the presence This type of fracture (distal part of the forearm) is one of 1 3 Archives of Osteoporosis (2023) 18:30 Page 9 of 11 30 the most common fractures in a fall from standing height. mineral density, obviously develops at an earlier age than According to an epidemiological study in Russia, its fre- the main many GSs. However, osteoporosis is diagnosed quency was 426/100,000 of the population, exceeding the at an older age, when GSs already appear and are detected incidence of femoral fracture by 3–7 times in men and 4–8 (addiction in everyday life, various sensitivity disorders, times in women, and significantly prevailing in women. In frailty syndrome, malnutrition, signs of immobility, our study, the first fracture of the radial bone most often such as fecal incontinence, bedsores, and falls, as well as occurred at the age of 65–74 years, but a repeated fracture chronic pain). It should be noted that in patients of the of the same location was registered already at the age of age categories considered, significant hormonal changes 75–84 years, which is consistent with the data that the risk occur in the body, namely the levels of growth hormone, of a subsequent fracture after the initial fracture increases sex hormones, and insulin-like growth factor as well as by 1.6–4.3 times at any age [19]. their bioavailability (decreases). Such changes lead to However, it is noteworthy that in 594 (15.77%) patients impaired osteogenesis and increased bone resorption. A with a history of fracture in the subanalysis presented, significant contribution to the pathogenesis of bone aging osteoporosis was not diagnosed and, accordingly, no is due to vitamin D deficiency that increases with age treatment was prescribed. When analyzing data from 6 and is aggravated by such GSs as malnutrition. Such an European countries (France, Spain, Italy, Great Britain, association of GSs and osteoporosis arises possibly, among Sweden), 60–85% of women with a history of fracture other things, due to increased immune inflammation and also did not receive subsequent treatment for osteoporosis secretion of pro-inflammatory interleukins (IL-1, IL-6) and [20]. Our study revealed that only 12 (4.7%) patients TNF. Aged patients have decreased glomerular filtration received antiresorptive therapy, 1 (0.4%) patient received rate which exacerbates age-related vitamin D deficiency. bone anabolic therapy, and 9 (3.5%) patients received both All these changes initiate the progression of osteoporosis antiresorptive and bone-metabolic therapy; however, 91.4% in patients over 65 years of age [23, 24]. Thus, geriatric of patients still confirmed the prescription of vitamin D and syndromes are associated with the presence of osteoporosis calcium supplements. These data indicate insufficiently and its severity. The results of the association of most GSs complete treatment of osteoporosis. Similar results were and osteoporosis are consistent with the findings obtained obtained in Europe; thus, 71% of women with indications for in a study conducted at the Russian Gerontological anti-osteoporotic treatment did not receive this therapy [15]. Research and Clinical Center among patients of the These findings can be due to a number of factors, including geriatric therapy department, which revealed that patients the low awareness of doctors and patients about the need with osteoporosis had frailty syndrome, malnutrition, and for osteoporosis treatment, the need for long-term treatment physical inactivity significantly more often (p < 0.001) [25]. of osteoporosis, the high cost of drugs for the treatment So the geriatric status of older patients with osteoporosis of osteoporosis, and the large number of drugs taken for tends to be worse. other diseases. Thus, in the osteoporosis group, a greater It should be noted that weight loss and a decrease in number of patients were recorded who took 5 or more drugs. muscle mass/strength are associated with frailty syndrome Polypharmacy is a GS which is often cited as a potential and are signs of sarcopenia [26]. Sarcopenia is a progres- barrier to adherence to the regimen of drug intake, used to sive generalized skeletal muscle disorder associated with a treat osteoporosis, and is an independent negative factor in high risk of adverse outcomes, including falls, fractures, and long-term therapy [21]. It has been revealed that women physical disability as well as death. Sarcopenia and osteo- taking medications for other diseases were less adherent penia have common risk factors and pathogenesis and are to osteoporosis therapy, and those who used more than ten associated with myogenesis and osteogenesis. The combi- drugs had a 1.87-fold risk of being non-adherent compared nation of sarcopenia and osteoporosis/osteopenia is called to those who did not use medications [22]. sarcoosteopenia. In 2009, this term was first used in elderly Patients with osteoporosis have a high comorbidity, patients with a higher risk of falls, fractures, disability, and a burdened geriatric status [12]. Thus, in our study, the decrepitude [27]. In our study, muscle strength was assessed greatest number of GSs was revealed in patients with using carpal dynamometry (Table 4). In the osteoporosis osteoporosis, with the exception of orthostatic hypotension group, muscle strength was reduced in 73% of patients; in and hearing loss (Table 6). In addition, osteoporosis, being the same group, the SPPB score was lower (Table 4). Thus, associated with almost all GSs (OR 1.19–3.10), was not the decrease in these indicators in the osteoporosis group associated with orthostatic hypotension, hearing loss, and was due to osteosarcopenia. Age-related changes in the hor- cognitive impairment (Table 7). This could be explained by monal and metabolic status in combination with the majority the fact that patients over 65 years of age with osteoporosis of GSs and the probable development of osteosarcopenia, as frequently used hearing aids than patients without well as changes in the life status of a person with age, could osteoporosis (Table 5). Osteoporosis, as a change in bone explain the results of the multivariate analysis (Table 8). 1 3 30 Page 10 of 11 Archives of Osteoporosis (2023) 18:30 Machekhina Lubov V.—substantial contributions to conception and Conclusion design, acquisition of data, analysis and interpretation of data, and approval of the version to be published and all subsequent versions. Osteoporosis is a severe age-related disease that can lead Selezneva Elena V.—substantial contributions to conception and to poor outcomes. Geriatric syndromes are associated with design, acquisition of data, and analysis and interpretation of data. Ovcharova Lilia N.—substantial contributions to conception and the presence of osteoporosis and its severity; so the geriatric design acquisition of data and analysis and interpretation of data. status of older patients with osteoporosis tends to be worse. Kotovskaya Yulia V.—substantial contributions to conception and The association of osteoporosis with a large number of GSs design, or acquisition of data, analysis and interpretation of data, and aggravates the condition of these patients making treatment approval of the version to be published and all subsequent versions. Tkacheva Olga N.—substantial contributions to conception and difficult. Therefore, scheduled, early, and timely diagnosis design, acquisition of data, analysis and interpretation of data, and of osteoporosis (careful assessment of the history of falls, approval of the version to be published and all subsequent versions. fractures, and their localization, as well as changes in anthro- All authors read and approved the final manuscript. pometric parameters, namely reduced height) and GSs, as Data availability The data that support the findings of this study are well as development of an individual treatment plan to alle- available on request from the corresponding author [OnuchinaY.S.]. viate the condition of these patients, is of great clinical util- The data are not publicly available due to them containing information ity. “Treat the patient the way you would like to be treated” that could compromise research participant privacy/consent. is an ancient truth which is at the core of medicine. It is an obvious fact that important, new, and interesting conclusions Declarations were made in the EVKALIPT study, despite its complicated, Ethical approval and consent to participate All procedures performed time-consuming, and diverse nature. Success and efficiency in studies involving human participants were in accordance with the in the management are achieved only in a team approach to ethical standards of the institutional and/or national research commit- solving problems. Thus, it is necessary to adopt additional tee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Rus- programs at the state level to introduce information about sian Gerontology Research and Clinical Centre Ethics Committee (No. GSs and opportunities to work with elderly patients; timely 262). Informed consent was obtained from all individual participants (early) detection and correction of osteoporosis; and dis- included in the study. semination of information among medical workers, patients, and their relatives. Conflicts of interest None. Limitations of the study References 1. One of the disadvantages is the fact that the diagnosis of osteoporosis was revealed on the past medical history, 1. Beard JR, Officer A, de Carvalho IA et al (2016) The World report on ageing and health: a policy framework for healthy ageing. Lan- which limits us in comparison with other studies where cet 387(10033):2145–2154 DXA was performed. 2. Inouye SK, Studenski S, Tinetti ME, Kuchel GA (2007) Geriatric 2. The study focuses on 3 localizations of osteoporotic syndromes: clinical, research, and policy implications of a core fractures, which we believe are the most important geriatric concept. J Am Geriatr Soc 55:780–791 3. Rosso AL, Eaton CB, Wallace R, Gold R, Stefanick ML, Ockene and relevant. Other fractures are less often taken into JK et al (2013) Geriatric syndromes and incident disability in account by patients and doctors, and are more difficult older women: results from the women’s health initiative observa- to statistically analyze. tional study. J Am Geriatr Soc 61:371–379 4. Lesnyak OM, Baranova IA, Belova KYu, Gladkova EN, Evstign- eeva LP, Ershova OB, Karonova TL, Kochish AYu, Nikitinskaya OA, Skripnikova IA, Toroptsova NV, Aramisova RM (2018) Osteoporosis in the Russian Federation: epidemiology, medical, Author contribution Dudinskaya Ekaterina N.—substantial contri- social, and economic aspects of the problem (literature review). butions to conception and design, acquisition of data, analysis and Travmatologiya i ortopediya Rossii 24(1):155–167 interpretation of data, drafting the article or revising it critically for 5. Camacho PM, Petak SM, Binkley N et al (2020) American Asso- important intellectual content, and approval of the version to be pub- ciation of Clinical Endocrinologists/American College of Endo- lished and all subsequent versions. crinology Clinical Practice Guidelines for the Diagnosis and Treat- Vorobyeva Natalia M.—substantial contributions to conception and ment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract design, acquisition of data, analysis and interpretation of data, drafting 26(Suppl 1):1–46. https:// doi. org/ 10. 4158/ GL- 2020- 0524S UPPL the article or revising it critically for important intellectual content, and 6. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, approval of the version to be published and all subsequent versions. Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteo- Onuchina Julia S.—substantial contributions to conception and porosis in the European Union: medical management, epidemi- design, acquisition of data, analysis and interpretation of data, draft- ology and economic burden. A report prepared in collaboration ing the article or revising it critically for important intellectual content, with the International Osteoporosis Foundation (IOF) and the and approval of the version to be published and all subsequent versions. European Federation of Pharmaceutical Industry Associations 1 3 Archives of Osteoporosis (2023) 18:30 Page 11 of 11 30 (EFPIA). Arch Osteoporos  8(1):136. https:// doi. or g/ 10. 1007/ morphometric analysis. Osteoporoz i osteopatii [Osteoporosis and s11657- 013- 0136-1 and Bone Diseases] 2:2–6 7. Vorobyeva NM, Tkacheva ON, Kotovskaya Yu V et al (2021) 19. Hodsman AB, Leslie WD, Tsang JF et al (2008) 10-year probability Russian epidemiological study EVKALIPT: protocol and basic of recurrent fractures following wrist and other osteoporotic fractures characteristics of participants. Russ J Geriatr Med (1):35–43 in a large clinical cohort: an analysis from the Manitoba Bone Density 8. Tkacheva ON, Runikhina NK, Ostapenko VS et al (2018) Preva- Program. Arch Intern Med 168(20):2261–2267 lence of geriatric syndromes among people aged 65 years and older 20. Borgström F et al (2020) Fragility fractures in Europe : burden, at four community clinics in Moscow. Clin Interv Aging 251–259 management and opportunities. Arch Osteoporos 15:59 9. Tkacheva ON, Runikhina NK, Ostapenko VS et al (2017) Vali- 21. Weiss TW, Henderson SC, McHorney CA, Cramer JA (2007) Persis- dation of the questionnaire for screening frailty. Adv Gerontol tence across weekly and monthly bisphosphonates: analysis of US retail 30(2):236–242 pharmacy prescription refills. Curr Med Res Opin 23(9):2193–2203 10. Tkacheva N, Yu V, Kotovskaya NK, Runikhina EV et al (2020) 22. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Clinical recommendations frailty syndrome. Russ J Geriatr Med Determinants of non-compliance with bisphosphonates in (1):11–46 women with postmenopausal osteoporosis. Curr Med Res Opin 11. Tkacheva ON, Kotovskaya YV, Runikhina NK et al (2020) Clini- 24(5):1337–1344 cal guidelines frailty. Part 2. Russ J Geriatr Med (2):115–130. 23. Soysal P, Stubbs B, Lucato P et al (2016) Inflammation and frailty https:// doi. org/ 10. 37586/ 2686- 8636-2- 2020- 115- 130 in the elderly: a systematic review and meta-analysis. Ageing Res 12. Aspray TJ, Hill TR (2019) Osteoporosis and the ageing skeleton. Rev 31:1–8. https:// doi. org/ 10. 1016/j. arr. 2016. 08. 006 Subcell Biochem 91:453–476. https:// doi. org/ 10. 1007/ 978- 981- 24. Ma L, Sha G, Zhang Y, Li Y (2018) Elevated serum IL-6 and 13- 3681-2_ 16 adiponectin levels are associated with frailty and physical function 13. Vondracek SF, Linnebur SA (2009) Diagnosis and management in Chinese older adults. Clin Interv Aging 13:2013–2020. https:// of osteoporosis in the older senior. Clin Interv Aging 4:121–136doi. org/ 10. 2147/ CIA. S1809 34 14. Sarafrazi N, Wambogo EA, Shepherd JA (2021) Osteoporosis or 25. Khovasova NO, Naumov AV, Tkacheva ON, Dudinskaya EN low bone mass in older adults: United States, 2017–2018. NCHS (2021) Characteristics of geriatric and somatic status in patients Data Brief (405):1–8 with osteoporosis. Problemy endokrinologii, No 67(3):45–54 15. Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lor- 26. Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. Lancet entzon M, McCloskey EV, Willers C, Borgström F (2021) SCOPE 393(10191):2636–2646 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos 27. Binkley N, Buehring B (2009) Beyond FRAX: It’s time to con- 16(1):82. https:// doi. org/ 10. 1007/ s11657- 020- 00871-9 sider ‘sarco-osteopenia.’ J Clin Densitom 12(4):413–416 16. Lesnyak OM, Ershova OB, Belova KYu, Gladkova EN et al (2014) Epidemiology of osteoporotic fractures in the Russian Federation Publisher's note Springer Nature remains neutral with regard to and the Russian FRAX model. Osteoporoz i osteopatii, No 3:3–8 jurisdictional claims in published maps and institutional affiliations. 17. Johansson L, Sundh D, Nilsson M et al (2018) Vertebral fractures and their association with health-related quality of life, back pain Springer Nature or its licensor (e.g. a society or other partner) holds and physical function in older women. Osteoporos Int 29(1):89–99 exclusive rights to this article under a publishing agreement with the 18. Evstigneeva LP,  Piven AI (2001) Epidemiology of osteoporo- author(s) or other rightsholder(s); author self-archiving of the accepted tic vertebral fractures among population sample of inhabitants manuscript version of this article is solely governed by the terms of of the Yekaterinburg city of 50 years and older based on X-ray such publishing agreement and applicable law. Authors and Affiliations 1 2 1,3 1 Ekaterina N. Dudinskaya  · Natalia M. Vorobyeva  · Julia S. Onuchina  · Lubov V. Machekhina  · 4 4 5 5,6 Elena V. Selezneva  · Lilia N. Ovcharova  · Yulia V. Kotovskaya  · Olga N. Tkacheva Ekaterina N. Dudinskaya Laboratory of Cardiovascular Aging, Russian Gerontology katharina.gin@gmail.com Research and Clinical Centre, Pirogov Russian National Research Medical University, Moscow, Russia Natalia M. Vorobyeva vorobyeva_nm@rgnkc.ru Department of Aging Diseases, Faculty of Additional Professional Education, Russian Gerontology Research Lubov V. Machekhina and Clinical Centre, Pirogov Russian National Research mlv66@list.ru Medical University, Moscow, Russia Yulia V. Kotovskaya Institute for Social Policy, National Research University kotovskaya_yv@rgnkc.ru “Higher School of Economics”, Moscow, Russia Olga N. Tkacheva Russian Gerontology Research and Clinical Centre, Pirogov tkacheva@rgnkc.ru Russian National Research Medical University, Moscow, Russia Age-Related Endocrine and Metabolic Disorders Laboratory, Russian Gerontology Research and Clinical Centre, Pirogov Russian Academy of Sciences, Moscow, Russia Russian National Research Medical University, Moscow, Russia 1 3

Journal

Archives of Osteoporosis – Springer Journals

Published: Feb 13, 2023

Keywords: Older age; Osteoporosis; Fractures; Geriatric syndromes

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