Vertebral Fractures Predict Subsequent Fractures

Melton, L. Joseph; Atkinson, Elizabeth J.; Cooper, Colin; O’Fallon, W. Michael; Riggs, B. Lawrence

doi:10.1007/s001980050218

Cited by 432 publications

(220 citation statements)

References 42 publications

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“…In Olmsted County, any of the traditional osteoporotic fractures preceded a prevalent vertebral fracture in 55% of postmenopausal women, compared with 21% of controls, but these consisted predominantly of earlier vertebral fractures. 8 Excluding them, only 12% of cases and 11% of controls had a prior distal forearm fracture alone, and the risk of a vertebral fracture that could be 'attributed' to a prior forearm fracture in our data was only 13%. Others, however, have reported a much greater prevalence of prior fractures.…”

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confidence: 54%

“…Thus, the idea of a characteristic cascade from forearm to spine to hip fractures is based on descriptive epidemiologic data on fracture incidence. Among adult women in our community, for example, the mean age at hip fracture (82.0 years) 7 is indeed greater than the average age (74.1 years) at the time of a spine fracture, 8 which in turn is greater than the mean age (65.5 years) at the first distal forearm fracture. 9 The situation is less clear in men.…”

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confidence: 72%

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Is there a specific fracture ‘cascade’?

Melton¹,

Amin²

2013

BoneKEy Reports

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Different kinds of epidemiologic data provide varying views of the relationships among the main osteoporotic fractures. Descriptive incidence data indicate that distal forearm fractures typically occur earlier than vertebral fractures that, in turn, precede hip fractures late in life. In addition, relative risk estimates document the fact that one osteoporotic fracture increases the risk of subsequent ones. These two observations support the notion of a 'fracture cascade' and justify the recent emphasis on secondary prevention, that is, more aggressive treatment of patients presenting with a fracture in order to prevent recurrences. However, the absolute risk of a subsequent fracture given an initial one is modest, and the degree to which the second fracture can be attributed to the first one is unclear. Moreover, the osteoporotic fractures encountered in the majority of patients are the first one experienced, and even these initial fractures lead to substantial morbidity and cost. These latter points reemphasize the importance of primary prevention, that is, the management of bone loss and other risk factors to prevent the first fracture. Continued efforts are needed to refine risk assessment algorithms so that candidates for such fracture prophylaxis can be identified more accurately and efficiently. The term, 'fracture cascade,' has most often been applied in the context of sequential vertebral fractures. 1 This is a wellrecognized phenomenon relating to an underlying predisposition (compromised bone structure and strength in the thoracic and lumbar vertebrae) combined with regular exposure to the excessive spinal loads that can result from everyday activities. 2 However, biomechanical alterations that result from each new fracture are also thought to have a role. 3 This may account for the clustering of fractures in neighboring vertebrae that is often observed 4 and could be an explanation for the increased risk of fracture in adjacent vertebrae sometimes seen following vertebroplasty/kyphoplasty. 5 Although there is little question about the heightened risk of serial vertebral fractures, attention has recently been called to the need for a more aggressive focus on treating all osteoporotic fractures in order to prevent subsequent ones, 6 that is, secondary prevention. Consequently, it becomes important to determine the extent to which there also is a more general fracture cascade, or cycle, from one specific type of osteoporotic fracture to another. Different types of epidemiologic data provide varying perspectives on this question.It is generally understood in this regard that forearm fractures typically occur earlier in life among women, especially around the time of menopause, followed by vertebral fractures in midlife and hip fractures among the oldest old. This notion is captured beautifully in the classic figure by John Kanis and the late Olof Johnell (Figure 1), although that figure pertains specifically to the accumulation of fracture-related morbidity over life rather than to the occurrence of frac...

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confidence: 54%

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confidence: 72%

Is there a specific fracture ‘cascade’?

Melton¹,

Amin²

2013

BoneKEy Reports

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“…There are a number of factors that may explain the prevalence of new fractures adjacent to a previously augmented vertebra, including: the distribution and amount of the cement fill, degree of osteoporosis, spinal malalignment, increased patient physical function following surgery [11,30,35], and intervertebral disc health. Endplate Fig.…”

Section: Discussionmentioning

confidence: 99%

Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation

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“…In the present study, there was a comparatively high frequency of vertebral fractures in MS patients (2% in the present study vs. 0.3% in the Danish study). Vertebral fragility fractures are typically associated with older osteoporotic patients [19].Vertebral fragility fractures are a very strong risk factor for subsequent hip and vertebral fracture [4,20]. Only one population-based study on determinants of thoracic vertebral fractures in 57,480 Finnish population has been performed in the 1990s [21].…”

Section: Discussionmentioning

confidence: 99%

High Frequency of Fractures in an Early Stage of MS

Krökki¹,

Bloigu²,

Remes

2013

J Mult Scler

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Objective: Low-energy (fragility) fractures of the distal forearm, femur, and vertebrae are usually associated with osteoporosis. There is an increased risk of fractures and low bone mineral density in patients with MS, even during the early stages of the disease. We evaluated the prevalence and features of low-energy fractures in a populationbased MS cohort residing in a region of Finland near the Arctic. Methods:The prevalence of fractures was determined in 491 patients who had been newly diagnosed with clinically definite MS. The fracture type, as well as the association between the duration of MS and the expanded disability status scale (EDSS) score, with a fracture event was determined. Results:The prevalence of fragility fractures was 7.1%. The most frequent fracture types were vertebral (19.2%), distal forearm (19.2%), and ankle (25%), and the majority were low-energy fractures. The majority of fractures occurred within five years of MS diagnosis verification in non-disabled to moderately disabled patients (EDSS score 0-4). The mean MS patient age at which low-energy fracture events occurred was 42.5 years (95% CI, 38.3-46.6 years). Osteoporosis had only been clinically investigated in 26% of patients with fragility fractures, 89% of whom returned a positive finding. Conclusions:The prevalence of low-energy vertebrae fractures was notably high in the present cohort; however, the presence of osteoporosis was poorly evaluated in clinical practice for this cohort.

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Vertebral Fractures Predict Subsequent Fractures

Cited by 432 publications

References 42 publications

Is there a specific fracture ‘cascade’?

Is there a specific fracture ‘cascade’?

Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation

High Frequency of Fractures in an Early Stage of MS

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