Incident vertebral fractures and mortality in older women: a prospective study

Abstract

Older persons who have prevalent vertebral fractures have an increased risk of mortality. It is not known whether incident vertebral fractures are also associated with an increased risk of mortality. To determine whether older women with incident vertebral fractures have an increased risk of mortality, we conducted a prospective cohort study of 7233 community-dwelling older women aged 65 years or older who were enrolled in the Study of Osteoporotic Fractures. We measured incident vertebral fractures by radiographic morphometry of paired lateral spine X-rays taken an average of 3.7 years apart. We also collected information on baseline prevalent vertebral fractures; calcaneal bone density; anthropometric measures; and demographic, medical history, and lifestyle variables. Overall mortality was assessed and confirmed by receipt of death certificates. Over an average of 3.7 years, 389 (5.4%) women developed at least one incident vertebral fracture. During an additional 8 years of follow-up, 1617 (22%) women died. Women with at least one new fracture had an age-adjusted 32% increased risk of mortality (RH=1.32; 95% CI=1.10-1.58, P=0.003) compared to those without incident vertebral fractures. After adjustment for weight loss, physical frailty markers, and nine other predictors of mortality, there was no longer an independent association between incident vertebral fractures and mortality (RH=1.06; 95% CI=0.88 1.28). Older women with incident vertebral fractures have an increased risk of mortality that may be explained by weight loss and physical frailty.

Height loss starting in middle age predicts increased mortality in the elderly

“…Other studies reported that increased mortality after hip and vertebral fractures was consistent over the initial five-year period. (4,6,8,11) In the present study, prevalent morphometric vertebral deformity and prevalence of hip fracture were not associated with increased mortality. Inconsistency between our report and many previous studies can be explained by differences between incidence and prevalence of fracture, because prevalent vertebral deformity and hip fracture in our study included those cases that had developed many years in the past.…”

“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

“…Vertebral compression fractures (VCF) constitute a major health problem affecting more than 1.4 million people each year worldwide [1], leading to pain, significant morbidity [2,3], and healthcare expenses [4]. Non-surgical management (NSM) may not relieve pain, frequently leads to prolonged immobilization, and may lead to pulmonary deterioration, persistent pain, progressive kyphotic deformity, weight loss, depression, and overall compromise in life quality [2,5,6].…”

“…In addition, patients with VCF are prone to new adjacent fractures (a fivefold increase in risk) [7]. In one prospective study, elderly women with at least 1 VCF had an age-adjusted increased risk of mortality of 32 %; survival impact was more profound with greater numbers of vertebral fractures [3].…”

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

“…Thereby, bedsores may appear (often associated to infections), deep venous thrombosis, decrease of bone mineral density and muscle hypotonia. Other severe effects are mood impairment, depressive syndrome and, finally, higher mortality rate, as demonstrated by various studies [10][11][12][13]. Patients undergoing conservative treatment may also suffer serious consequences related to bracing incontinence [7,14], represented by progressive kyphosis as a result of multiple vertebral collapses, that can potentially lead to thoracic and abdominal visceral compression with severe systemic pathological manifestations.…”