Executive functions predict fracture risk in postmenopausal women assessed for osteoporosis
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ORIGINAL ARTICLE
Executive functions predict fracture risk in postmenopausal women assessed for osteoporosis Antonino Catalano1,2 · Alberto Sardella1 · Federica Bellone1,2 · Carmen Giulia Lasco1 · Gabriella Martino1 · Nunziata Morabito1,2 Received: 22 August 2019 / Accepted: 19 November 2019 © Springer Nature Switzerland AG 2019
Abstract Background Cognitive impairment and muscle strength have been associated with bone fragility. However, the potential predictive role of executive functions on fracture risk has been poorly investigated. Aim We intended to explore the association between executive functions, psychological distress and physical performance with fracture risk in postmenopausal women. Methods Cognitive tests explicating executive functions (i.e., Trial Making Test-B, Digit Span Backward, Digit Span Forward) and questionnaires assessing psychological distress (i.e., Back Depression Inventory and Hamilton Anxiety Scale) were administered. Physical performance was explored through the Short Physical Performance Battery and handgrip strength. The 10-year probability of major and hip fractures was assessed by Fracture Risk Assessment tool (FRAX); the bone mineral density (BMD) was evaluated by Dual-Energy X-ray Absorptiometry. Results 60 women (mean age 66 ± 7.99 yr.) were recruited. The FRAX score for major fractures was significantly associated with Trial Making Test B score (r = − 0.25) and with Digit Span Backward (r = − 0.34); the FRAX score for hip fracture was associated with handgrip strength (r = − 0.39, p = 0.002). BMD was significantly associated with Digit Span Backward (r = − 0.32) and with depression (r = − 0.33). After several adjustments, the multiple regression analysis showed that BMI (ß = 0.09, SE 0.03, p = 0.013), Beck Depression Inventory score (ß = − 0.09, SE 0.06, p = 0.04) and Digit Span Backward score (ß = 0.55, SE 0.17, p = 0.002) were independently predictive of lumbar BMD. Conclusions Verbal working memory, as assessed by Digit Span Test, and psychological features were associated with BMD and could contribute to fracture risk prediction in postmenopausal women. Keywords Executive functions · Osteoporosis · Fracture risk · Bone mineral density · Postmenopausal
Introduction Osteoporosis is one of the most common chronic diseases, which typically affects postmenopausal women, and represents an increasingly relevant public health concern [1]. Patients suffering from osteoporosis frequently show high psychological burden in terms of decreased quality of life and higher incidence of depression and anxiety symptoms * Antonino Catalano [email protected] 1
Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 9812 Messina, Italy
Unit and School of Geriatrics, University of Messina, Messina, Italy
2
[2, 3]. Specifically, anxiety levels were recently found to be predictive of fracture risk in postmenopausal women with osteoporosis [4]. Nevertheless, several studies suggested that chronic psychological stress might be a relev
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