The assessment of vertebral fractures in elderly women with recent hip fractures: the BREAK Study

Abstract

Summary This study aimed to evaluate the prevalence of vertebral fractures in elderly women with a recent hip fracture. The burden of vertebral fractures expressed by the Spinal Deformity Index (SDI) is more strictly associated with the trochanteric than the cervical localization of hip fracture and may influence short-term functional outcomes. Introduction This study aimed to determine the prevalence and severity of vertebral fractures in elderly women with recent hip fracture and to assess whether the burden of vertebral fractures may be differently associated with trochanteric hip fractures with respect to cervical hip fractures. Methods We studied 689 Italian women aged 60 years or over with a recent low trauma hip fracture and for whom an adequate X-ray evaluation of spine was available. All radiographs were examined centrally for the presence of any vertebral deformities and radiological morphometry was performed. The SDI, which integrates both the number and the severity of fractures, was also calculated. Results Prevalent vertebral fractures were present in 55.7 % of subjects and 95 women (13.7 %) had at least one severe fracture. The women with trochanteric hip fracture showed higher SDI and higher prevalence of diabetes with respect to those with cervical hip fracture, p00.017 and p00.001, respectively. SDI, surgical menopause, family history of fragility fracture, and type2 diabetes mellitus were independently associated with the risk of trochanteric hip fracture. Moreover, a higher SDI was associated with a higher percentage of postsurgery complications (p00.05) and slower recovery (p<0.05). Conclusions Our study suggests that the burden of prevalent vertebral fractures is more strictly associated with the trochanteric than the cervical localisation of hip fracture and that elevated values of SDI negatively influence short term functional outcomes in women with hip fracture.

Prevalence and burden of vertebral fractures in older men and women with hip fracture: A cross‐sectional study

“…Among the covariates included in the logistic regression models, age and ability to function in activities of daily living were significantly associated with prevalent vertebral fractures. This result is in agreement with several previous reports . We found no significant associations between hip‐fracture type (either cervical or trochanteric) and prevalent vertebral fractures.…”

“…We found no significant associations between hip‐fracture type (either cervical or trochanteric) and prevalent vertebral fractures. Previous studies on this issue showed inconsistent results: either no differences or a higher prevalence in trochanteric fractures were reported . Inconsistencies might be a result of several confounders that could affect the comparison between patients with either cervical or trochanteric fractures …”

“…We found a high prevalence of vertebral fractures (69%, 95% CI 65–74%) in our sample of 411 hip‐fracture women. This result is in agreement with the prevalence reported in three previous studies of women following a hip fracture, (63% of 143, 66% of 164 and 74% of 132), whereas a single previous study showed a prevalence slightly lower than the one shown in our sample (56% of 689; 95% CI 52–60%) …”

“…Furthermore, sarcopenia and falls are strictly associated with osteoporosis, and falls often recur in the same subject, thus contributing to increasing the individual risk of new fractures after the first one . Several prospective studies have consistently shown that previous vertebral fractures enhance the risk of subsequent hip fractures, and the proportion of hip‐fracture women with at least one prevalent spine fracture is high, ranging from 55% to 74%, as shown by the few cross‐sectional studies that addressed this issue …”

“…[12][13][14][15][16] Several prospective studies have consistently shown that previous vertebral fractures enhance the risk of subsequent hip fractures, and the proportion of hip-fracture women with at least one prevalent spine fracture is high, ranging from 55% to 74%, as shown by the few cross-sectional studies that addressed this issue. [17][18][19][20][21][22] Although osteoporosis is often considered a women's disease, between 30 and 40% of fragility fractures occur in men, and the lifetime risk of fracture for men aged 50 years or older is between 13 and 30%. 23 Furthermore, the clinical consequences of the most relevant fragility fractures are worse in men than in women, with higher mortality rates, higher morbidity and lower functional recovery.…”