Determinants of the Size of Incident Vertebral Deformities in European Men and Women in the Sixth to Ninth Decades of Age: The European Prospective Osteoporosis Study (EPOS)

Abstract

More severe vertebral fractures have more personal impact. In the European Prospective Osteoporosis Study, more severe vertebral collapse was predictable from prior fracture characteristics. Subjects with bi-concave or crush fractures at baseline had a 2-fold increase in incident fracture size and thus increased risk of a disabling future fracture.Introduction: According to Euler's buckling theory, loss of horizontal trabeculae in vertebrae increases the risk of fracture and suggests that the extent of vertebral collapse will be increased in proportion. We tested the hypothesis that the characteristics of a baseline deformity would influence the size of a subsequent deformity. Methods: In 207 subjects participating in the European Prospective Osteoporosis Study who suffered an incident spine fracture in a previously normal vertebra, we estimated loss of volume (fracture size) from plane film images of all vertebral bodies that were classified as having a new fracture. The sum of the three vertebral heights (anterior, mid-body, and posterior) obtained at follow-up was subtracted from the sum of the same measures at baseline. Each of the summed height loss for vertebrae with a McCloskey-Kanis deformity on the second film was expressed as a percentage. Results and Conclusions:In univariate models, the numbers of baseline deformities and the clinical category of the most severe baseline deformity were each significantly associated with the size of the most severe incident fracture and with the cumulated sum of all vertebral height losses. In multivariate modeling, age and the clinical category of the baseline deformity (crush Ͼ bi-concave Ͼ uni-concave Ͼ wedge) were the strongest determinants of both more severe and cumulative height loss. Baseline biconcave and crush fractures were associated at follow-up with new fractures that were approximately twice as large as those seen with other types of deformity or who previously had undeformed spines. In conclusion, the characteristics of a baseline vertebral deformity determines statistically the magnitude of vertebral body volume lost when a subsequent fracture occurs. Because severity of fracture and number of fractures are determinants of impact, the results should improve prediction of the future personal impact of osteoporosis once a baseline prevalent deformity has been identified. J Bone Miner Res 2003;18:1664 -1673Key words: osteoporosis, vertebral fractures, cohort study, radiological morphometry, fracture risk INTRODUCTION T HE IMPACT OF osteoporotic vertebral fractures has become the subject of increasing attention.(1-4) Because nonspecific or mechanical back pain is common, it has proved sometimes difficult to show the impact of osteoporotic fractures in the vertebral bodies. These are relatively uncommon in populations but were thought to have a large impact on affected individuals. In more recent work, better instruments have been used to measure impact in terms of activities of daily living, bodily function, and pain. (3,5,6) It has become clear t...

Effect of gonadal status on bone mineral density and radiological spinal deformities in adult patients with growth hormone deficiency

“…In the last decade, the radiological morphometric assessment of vertebral deformities has emerged as the method of choice for evaluating the true prevalence of fractures in osteoporosis [16]. Moreover, vertebral deformities have been found to correlate well with the clinical outcome of the osteoporotic patients [17,18].…”

Glucocorticoid replacement therapy and vertebral fractures in hypopituitary adult males with GH deficiency

“…Finally, based on the lack of correlation between BMD and fractures, it appears reasonable to suggest to monitor glucocorticoid treatment by the morphometric approach in order to identify early and easily patients with unsuspected vertebral fractures. Epidemiological studies have pointed out the necessity to identify early vertebral fractures, since the presence of a single fracture even if mild and without clinical symptoms predisposes to have other more severe fractures with consequent greater clinical impact (38)(39)(40).…”

Detection of vertebral fractures

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