Vertebral fractures cascade: potential causes and risk factors

Che, H.; Breuil, Véronique; Cortet, Bernard; Paccou, Julien; Thomas, Thierry; Chapuis, Laure; Debiais, Françoise; Mehsen‐Cetre, Nadia; Javier, Rose‐Marie; Peres, S. Loiseau; Roux, Christian; Briot, Karine

doi:10.1007/s00198-018-4793-1

Cited by 42 publications

(31 citation statements)

References 44 publications

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“…19,20 However, as underscored by our study, it should be kept in mind that early or mild vertebral body compression fractures in patients with DMD may be overlooked by this method if there is less than 20% loss of vertebral height. Reliance on this method could therefore result in delays in treatment and development of the vertebral fracture cascade, 21 with progression to moderate and severe compression fractures.…”

Section: Discussionmentioning

confidence: 99%

The effect of oral bisphosphonate therapy on vertebral morphometry and fractures in patients with Duchenne muscular dystrophy and glucocorticoid‐induced osteoporosis

et al. 2021

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Introduction/Aims: Glucocorticoid-induced osteoporosis with vertebral fractures is frequent in patients with Duchenne muscular dystrophy (DMD). In this study, we evaluated the effects of oral bisphosphonate (BP) therapy on the prevalence and severity of vertebral fractures by vertebral morphometry assessment. Methods: We reviewed the records and radiographs of patients with DMD who had been treated with oral BP (weekly alendronate) and had undergone routine spine radiographic monitoring for glucocorticoid-induced osteoporosis at Cincinnati Children's Hospital Medical Center between 2010 and 2017. Study outcomes were thoracic and lumbar vertebral fracture prevalence and severity, assessed by Genant semiquantitative grading of vertebral morphometry, for up to 5 years of treatment.Results: Fifty-two patients (median age, 11.8 years; 88% prepubertal; 31% nonambulatory) had been treated with long-term glucocorticoids (median duration, 4.7 years at BP start). Most patients (75%) had mild vertebral height loss or fractures

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Section: Discussionmentioning

confidence: 99%

The effect of oral bisphosphonate therapy on vertebral morphometry and fractures in patients with Duchenne muscular dystrophy and glucocorticoid‐induced osteoporosis

et al. 2021

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“…In the overall population, the incidence of a new vertebral fracture in the subsequent year after suffering an incident vertebral fracture was 19.2% (95% CI 13.6-24.8%) [31]. Thereby, the presence of a vertebral fracture greatly increases the risk of sustaining subsequent vertebral fractures, a phenomenon often referred to as "vertebral fracture cascade" [31,33,34]. In the retrospective case-series (n = 113, 79.6% of women, median age 73) performed by Che et al [34], vertebral fracture cascade was defined as an occurrence of at least three vertebral fractures within 1 year.…”

Section: Vertebral Fracture and Risk Of Further Fracturesmentioning

confidence: 99%

“…Thereby, the presence of a vertebral fracture greatly increases the risk of sustaining subsequent vertebral fractures, a phenomenon often referred to as "vertebral fracture cascade" [31,33,34]. In the retrospective case-series (n = 113, 79.6% of women, median age 73) performed by Che et al [34], vertebral fracture cascade was defined as an occurrence of at least three vertebral fractures within 1 year. Several authors found that those with at least one prevalent vertebral fracture on VFA had increased hazard ratios (HR) for incident clinical fractures [35][36][37].…”

Section: Vertebral Fracture and Risk Of Further Fracturesmentioning

confidence: 99%

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

et al. 2021

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Summary Vertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS. Summary points • Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture. • Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA. • Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds. • Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment. • Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment...

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“…(1,3) It has long been known in adults that PVF presage future adverse events, including IVF. (19,20) Recent studies in the pediatric population have confirmed that PVF are also a potent predictor of subsequent bone morbidity in this age group, including the development of IVF. (14)(15)(16) Bone health monitoring of children and adolescents at risk for VF could be enhanced with the least necessary radiation exposure by using a targeted case finding approach to identify those with the highest likelihood of having PVF and who should therefore have radiographs performed.…”

Section: Introductionmentioning

confidence: 98%

“…VF are usefully classified as being either prevalent VF (PVF), those present at the time of initial assessment, or incident VF (IVF), those that develop during subsequent clinical monitoring . It has long been known in adults that PVF presage future adverse events, including IVF . Recent studies in the pediatric population have confirmed that PVF are also a potent predictor of subsequent bone morbidity in this age group, including the development of IVF .…”

Section: Introductionmentioning

confidence: 99%

The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

Siminoski

Wang

Alos

et al. 2019

Journal of Bone and Mineral Research

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Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case‐finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual‐energy X‐ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty‐four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z‐score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z‐score cutoff of −1.6. Case identification using either low BMD alone (Z‐score < −1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research.

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Vertebral fractures cascade: potential causes and risk factors

Cited by 42 publications

References 44 publications

The effect of oral bisphosphonate therapy on vertebral morphometry and fractures in patients with Duchenne muscular dystrophy and glucocorticoid‐induced osteoporosis

The effect of oral bisphosphonate therapy on vertebral morphometry and fractures in patients with Duchenne muscular dystrophy and glucocorticoid‐induced osteoporosis

Vertebral fracture: epidemiology, impact and use of DXA vertebral fracture assessment in fracture liaison services

The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

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