Fracture probability assessed using FRAX® in elderly women with benign paroxysmal positional vertigo
Introduction
Dizziness and vertigo are the most common symptoms among outpatients seen in the emergency room and in departments of neurology and otolaryngology. Benign paroxysmal positional vertigo (BPPV) is the most frequent diagnosis among these patients, and accounted for 19.7% of 2734 patients with vertigo and dizziness in one study [1]. BPPV is characterized by spinning sensations accompanied by nausea, is induced by sudden head movements, and typically lasts fewer than 60 s but can recur with further movements [2]. The pathophysiology involves abnormal stimulation of the cupula by floating otoliths or otoliths attached to the cupula in any of three semicircular canals with a change in head position [3], [4]. BPPV is treated by specific canalith-repositioning maneuvers, although remission can occur in several days without treatment [2], [4].
The lifetime prevalence of BPPV is 3.2% in women and 1.6% in men, and the 1-year prevalence is almost seven times higher in people older than 60 years than in people aged 18–39 years [5]. The prevalence of undiagnosed BPPV is 9% in elderly populations [6]. The prevalence rates of osteoporosis of the lumbar spine and femoral neck in women aged over 40 years are 19.2% and 26.5%, respectively [7], [8]. An association between BPPV and osteoporosis has previously been reported. Women aged 20–69 years with BPPV have lower bone mineral density compared with controls, and 75% of women with BPPV aged 50–85 years have osteoporosis on dual X-ray absorptiometry of the spine and hip [9]. Many patients with BPPV have vitamin D deficiency, which can simultaneously affect both bone and the inner ear [10], [11]. This suggests that patients with osteoporosis may develop BPPV.
The World Health Organization Fracture Risk Assessment Tool, known as FRAX® (http://www.shef.ac.uk/FRAX), is a computer-based algorithm for assessing fracture risk that was originally developed for use by clinicians to identify patients at risk of fracture in regions where bone density tests are unavailable. FRAX comprises 12 questions and includes an option for measuring bone mineral density. The use of this instrument is recommended when considering osteoporosis treatment.
We hypothesized that the fracture probability calculated using FRAX in patients with BPPV would be high. To date, no direct comparison has been made between the FRAX scores of patients with BPPV and controls. To determine whether the relative fracture risk is elevated in patients with BPPV and to identify any association between the FRAX score and BPPV, we assessed the FRAX-based 10-year hip fracture risk and 10-year major osteoporotic fracture risk among BPPV patients. Determining whether BPPV patients are at high risk of fracture may help to prevent future fractures by implementing FRAX-based interventions.
Section snippets
Participants
The study was approved by the Ethics Committee of Gifu Prefectural Tajimi Hospital. Informed consent was obtained from all study participants.
A total of 40 women who visited Gifu Prefectural Tajimi Hospital between July 2015 and April 2016 who were diagnosed with BPPV according to the criteria documented by the Barany Society were enrolled in this study [12]. The patients included 21 patients with a diagnosis of the posterior canal type and 19 patients with a diagnosis of the horizontal canal
Results
The 10-year probabilities of major osteoporotic fractures and hip fractures were calculated using FRAX for the 40 BPPV patients (aged 72.4 ± 8.6 years) and 40 controls (aged 71.2 ± 6.3 years). The 10-year major osteoporotic fracture probability correlated significantly with age in the BPPV group (r = 0.76, p < 0.0001, Fig. 1A) and in controls (r = 0.84, p < 0.0001, Fig. 1B). Similarly, the 10-year hip fracture probability correlated significantly with age in the BPPV group (r = 0.73, p < 0.0001, Fig. 2A) and in
Discussion
Our results indicate that the risks of 10-year major osteoporotic and hip fractures, calculated using FRAX, are higher in elderly women with BPPV than in controls without BPPV. This agrees with the relationship between BPPV and osteopenia or osteoporosis previously reported by several groups [9], [15]. The risk of fracture increases with age in all people but increases markedly in those with BPPV. It is therefore essential to evaluate fracture risk in elderly patients with dizziness and vertigo
Acknowledgments
We thank Dr. Aya Nakamura and Dr. Minori Yasue for assistance with participant recruitment, Dr. Yasue Uchida and Dr. Saiko Sugiura for assistance with statistical analysis, and Dr. Tsutomu Nakashima for advice.
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The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV)
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Otoconia is made up of calcium carbonate crystals and an organic core that has a similarity to bone tissue in the human body and contains % calcium ions, as shown by He, Li, Hou et al. [30]. Calcium metabolism disorders and low levels of vitamin D, according to popular wisdom, can be linked to otolith movement in BPPV [31,32]. BPPV may be caused by a disorder of calcium equilibrium in osteoporosis cases, according to Lee S, Lee C, Kim Y, and Kim H [33].
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2020, Auris Nasus LarynxCitation Excerpt :BPPV can occur in both sexes at any age, yet it is most common in middle-aged and elderly females [1]. Recently, the occurrence and/or recurrence of BPPV has been reported to be associated with osteopenia/osteoporosis and/or vitamin D deficiency [3–16]. Calcium metabolism is important for the synthesis and absorption of otoconia, as they are composed of calcium carbonate.
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2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :A strong correlation was demonstrated between serum level of otolin-1, which is the main protein of otoconia, and T-score of BMD, further supporting the association between BPPV and osteoporosis [21]. Moreover, BPPV patients may have a higher risk of fracture [22]. It was reported that medication for osteoporosis such as calcium and vitamin D supplements contributes to reducing the occurrence/recurrence rate of BPPV [23,24].
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2019, European Archives of Oto-Rhino-Laryngology