Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study

Kanterewicz, Eduardo; Puigoriol, Emma; Cros, José Ramón Rodríguez; Peris, Pilar

doi:10.1007/s00198-019-04962-3

Cited by 17 publications

(12 citation statements)

References 23 publications

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“…However, few such longitudinal observational studies with high participation rates have been reported, representing the principal strength of this study. Population-based studies reporting the incidence of VF have been performed in Western countries such as the USA [28], the Netherlands [13], and Spain [29] and in a multicenter study involving 19 European countries [30]. The reported incidence of VF varies from 0.5%/year to 1.5%/year, reflecting differences in ethnicities, mean ages of the participants, and criteria used to define VF.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalent morphometrical VF has been reported as a strong risk factor for incident VF [9,10,12,13]; however, mVF has not been studied sufficiently in the perspective of risk factors for incident sVF. A few studies have reported mVF as a risk factor for incident VF in women [14][15][16], but to the best of our knowledge, no reports exist on mVF as a risk factor in men. Furthermore, mVF has been reported to have low clinical relevance in cross-sectional studies [17,18].…”

Section: Introductionmentioning

confidence: 94%

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The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys

et al. 2021

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This population-based cohort study with a 3-year follow-up revealed that the annual incidence rates of vertebral fracture (VF) and severe VF (sVF) were 5.9%/year and 1.7%/year, respectively. The presence of mild VF at the baseline was a significant risk factor for incident sVF in participants without prevalent sVF. Introduction This study aimed to estimate the incidence of morphometric vertebral fracture (VF) and severe VF (sVF) in men and women and clarify whether the presence of a mild VF (mVF) increases the risk of incident sVF. Methods Data from the population-based cohort study, entitled the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, were analyzed. In total, 1190 participants aged ≥ 40 years (mean age, 65.0 ± 11.2) years completed whole-spine lateral radiography both at the third (2012-2013, baseline) and fourth surveys performed 3 years later (2015-2016, follow-up). VF was defined using Genant's semi-quantitative (SQ) method: VF as SQ ≥ 1, mVF as SQ = 1, and sVF as SQ ≥ 2. Cumulative incidence of VF and sVF was estimated. Multivariate logistic regression analyses were performed to evaluate risk factors for incident sVF. ResultsThe baseline prevalence of mVF and sVF were 16.8% and 6.0%, respectively. The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The annual incidence rates of sVF in participants without prevalent VF, with prevalent mVF, and with prevalent sVF were 0.6%/year, 3.8%/year, and 11.7%/year (p < 0.001), respectively. Multivariate logistic regression analyses in participants without prevalent sVF showed that the adjusted odds ratios for incident sVF were 4.12 [95% confident interval 1.85-9.16] and 4. 53 [1.49-13.77] if the number of prevalent mVF at the baseline was 1 and ≥ 2, respectively. Conclusions The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The presence of prevalent mVF was an independent risk factor for incident sVF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys

et al. 2021

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“…We disagree. Kanterewicz et al (2) used follow-up scans to identifying incident VFs in their cohort, in contrast to our study, in which we only used digital x-rays to verify clinical fractures, which have a much lower incidence than morphometric VFs. Thus, the incidence ratios for VFs cannot be compared between studies.…”

mentioning

confidence: 80%

“…Although there are similarities between previous studies and our study, there are important differences. Kanterewicz et al (2) examined a considerably younger age group (59-70 years) than the population of older women (75-80 years) included in our study. This is reflected by the large difference in VF prevalence at study inclusion (24.2% compared to 4.1%).…”

mentioning

confidence: 95%

“…(1) In their Letter, the authors point out that prior to our study, they had reported that VFA-verified prevalent minor vertebral deformities (MVDs) were associated with an increased risk of incident VFA-verified VF. (2) They also refer to other publications about associations between prevalent VF and incident VF, diagnosed by VFA. (3)(4)(5) Indeed, all these reports and our recent study to some extent support the usefulness of VFA to detect VF, and the importance of prevalent VF, including grade 1 VF or MVD, in assessing fracture risk in postmenopausal women.…”

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confidence: 99%

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Reply to: Grade 1 vertebral fractures, bone mineral density, and the risk of fractures

Johansson

Lorentzon

2021

Journal of Bone and Mineral Research

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We appreciate that Dr. E. Kanterewicz et al. have shown interest in our study, in which we investigated associations between grade 1 vertebral fracture (VF), verified by vertebral fracture assessment (VFA), and incident fractures. (1) In their Letter, the authors point out that prior to our study, they had reported that VFA-verified prevalent minor vertebral deformities (MVDs) were associated with an increased risk of incident VFA-verified VF. (2) They also refer to other publications about associations between prevalent VF and incident VF, diagnosed by VFA. (3)(4)(5) Indeed, all these reports and our recent study to some extent support the usefulness of VFA to detect VF, and the importance of prevalent VF, including grade 1 VF or MVD, in assessing fracture risk in postmenopausal women. Although there are similarities between previous studies and our study, there are important differences. Kanterewicz et al. (2) examined a considerably younger age group (59-70 years) than the population of older women (75-80 years) included in our study. This is reflected by the large difference in VF prevalence at study inclusion (24.2% compared to 4.1%). In the study by Kanterewicz et al., (2) both a morphometric classification and the Genant methods were used to identify VF, in contrast to our study, which solely utilized the Genant method, making it difficult to compare the results. It is also a fair assumption, that in the age group 75 to 80 years, identifying mild VFs is more challenging because of commonly present osteoarthritis, scoliosis, and sometimes impaired image quality, due to positioning difficulties, compared to younger age groups. As pointed out, by Kanterewicz et al. in their Letter, the study from Kadowaki et al. (3) found that prevalent vertebral deformities in middle-aged Japanese women were associated with a threefold increased risk for subsequent VF, but the prevalent vertebral deformities were not graded. Thus, the impact of mild vertebral deformities was not addressed, disabling a meaningful comparison with the results obtained in our study. (3) Ferrar et al. (4) graded prevalent VFs but could not find a significant association between prevalent mild VF and incident VF after adjustment for age and total hip bone mineral density (BMD). They also concluded that among postmenopausal women without prevalent VF but with short vertebral height (SVH) there was no association between SVH and incident VF. (4) Interestingly, this result contradicts the findings by Kanterewicz et al. (2) that MVD (vertebral height ratios between -2 and -2.99 standard deviations [SDs] below the reference) confers an increased risk of subsequent VF. Greendale et al. (5) found that two-thirds of the prevalent vertebral deformities were grade 1. They investigated

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Grade 1 vertebral fractures, bone mineral density, and the risk of fractures

Kanterewicz

Puigoriol

Peris

2021

Journal of Bone and Mineral Research

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Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study

Cited by 17 publications

References 23 publications

The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys

The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys

Reply to: Grade 1 vertebral fractures, bone mineral density, and the risk of fractures

Grade 1 vertebral fractures, bone mineral density, and the risk of fractures

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