Risk Factors for Vertebral and Nonvertebral Fracture Over 10 Years: A Population-Based Study in Women

Abstract

Risk factors may vary for different types of fracture, in particular for vertebral fractures. We followed 367 women >50 yr of age from a population-based cohort for up to 10 yr. Factors that predicted vertebral rather than nonvertebral fractures related to physical weakness, poor health, and weight loss. Similar factors were also associated with greater bone loss at the hip.Introduction: Many risk factors predict fractures overall, but it is less clear whether certain factors relate to vertebral fractures in particular. The aim of this study was to compare the risk factors for vertebral and nonvertebral fractures. Materials and Methods:We carried out a 10-yr prospective population-based study of 375 women who were 50-85 yr of age initially. At baseline, we measured BMD, blood and urine biochemistry, and anthropometric measurements. Medical and lifestyle data were obtained by questionnaire. Incident vertebral fractures were determined for 311 subjects from spinal radiographs at 0, 2, 5, 7, and 10 yr using an algorithm-based qualitative method, and nonvertebral fractures were confirmed radiographically. Relative risks were calculated by Cox regression analysis. Results: During follow-up, 70 subjects sustained one or more nonvertebral fractures and 29 sustained one or more vertebral fractures. Risk factors that predicted both types of fracture included increasing age, decreasing BMD at all sites, prevalent vertebral fracture, and shorter estrogen exposure. For nonvertebral fractures only, the risk factors included low urinary creatinine and less frequent use of stairs. The factors for vertebral fractures included lighter weight, reduced body fat, heavy smoking, lower serum calcium, albumin, and thyroid T 3 , weak grip strength, and poor physical capability. In a multivariate model, weight, fat mass, serum calcium and T 3 , prevalent vertebral fracture, and physical capability remained significant. Furthermore, grip strength, serum albumin, weight loss, and physical capability were associated with rate of bone loss at the femoral neck, and a fast rate of bone loss was also associated with vertebral fractures. Conclusions: We conclude that overall frailty, which may consist of general poor health, small or thin body size, and lack of strength and physical capability, predicts vertebral fractures but is not a significant predictor of nonvertebral fractures. Bone loss rates are associated with similar risk factors and also with the incidence of vertebral fractures.

Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS)

“…In the premenopausal group, one woman was identified with prevalent vertebral fracture; there were no incident vertebral fractures in this age group. The prevalence of vertebral fracture in this postmenopausal subset of OPUS is the same as in a previous study of postmenopausal women in which the ABQ method was used to identify vertebral fractures from spinal radiographs [10]. That study was also population based and included women of a similar age range (50 to 85 years at baseline) to our postmenopausal subset.…”

The skeletal consequences of thyrotoxicosis

“…A limited number of studies have investigated the relationship between incident fracture and circulating thyroid hormone concentrations within the euthyroid reference range. A 10-year prospective study of 367 healthy postmenopausal women found no association between thyroid hormone concentrations and vertebral fracture (Finigan et al 2008). Nevertheless, in a population of 130 euthyroid postmenopausal women with osteoporosis or osteopenia, Mazziotti et al (2010) reported that a TSH in the lower third of the reference range was independently associated with an increased risk of vertebral fracture.…”

High incidence of vertebral and non-vertebral fractures in the ostra-cohort study: A 5year follow-up study in postmenopausal women with rheumatoid arthritis

“…Finigan et al also found an incidence 1.9 of new vertebral fractures per 100 patient years in a 10-year follow-up populationbased study. Three hundred and sixty-seven female patients were included into this study with an age (64.6 years) at baseline which is comparable to our cohort [18]. Few studies have investigated the incidence of clinical fractures in RA patients.…”