Skip to main content
SpringerLink
Log in

Prevalent vertebral deformities: Relationship to bone mineral density and spinal osteophytosis in elderly men and women

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The aims of this study were to ascertain vertebral deformity prevalence in elderly men and women and to describe the association between bone mineral density (BMD) at the lumbar spine and femoral neck, severity of spinal degenerative disease and vertebral deformity prevalence. We performed standardized spinal radiographs in a random sample of 300 elderly men and women participating in the Dubbo Osteoporosis Epidemiology Study, a population-based study of fracture risk factors. Radiographs were read independently by masked observers for the prevalence of vertebral deformity and severity of osteophytosis. BMD was measured by dual-energy X-ray absorptiometry. The prevalence of vertebral deformities was critically dependent on the criterion used. The less strict criteria seemed to overestimate deformities at either end of the spine region analysed. However, irrespective of the criterion used, prevalence of deformity was higher in men than in women (25% vs 20% for the 3 SD criterion, 17% vs 12% for the 4 SD criterion and 27% vs 25% for the 25% criterion). Femoral neck BMD was more strongly associated with vertebral deformities than spinal BMD for the 25% criterion (OR/SD change in BMD 1.39 (p=0.02) vs 1.20 (p=0.19)), 3 SD criterion (OR/SD change in BMD 1.45 (p=0.01) vs 1.10 (p=0.34)) and 4 SD criterion (OR/SD change in BMD 1.98 (p=0.0002) vs 1.68 (p=0.008)). BMD was also more strongly associated with biconcave deformities than either wedge or crush deformities and more so in men than in women. Severity of spinal osteophytosis was not associated with vertebral deformity. In conclusion, femoral neck BMD is at least equivalent to the lumbar spine BMD in strength of association with prevalent vertebral fractures. Spinal osteophytosis falsely elevates BMD without a concomitant decrease in fracture risk, indicating that any interpretation of spinal BMD needs to be adjusted for osteophytosis. These findings support the use of femoral neck bone densitometry in older men and women. Moreover, these data indicate that current criteria for radiological assessment of vertebral deformity are sufficiently loose to include a substantial proportion of non-fractures in the elderly, with important implications for the design of clinical trials. However, irrespective of the criterion used, vertebral deformities in men are at least as common, if not more so, than in women, suggesting that vertebral osteoporotic fractures are overlooked in men.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Melton LJ, Kan SH, Frye MA, et al. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–11.

    Google Scholar 

  2. Cooper C, O'Neill T, Silman A. The epidemiology of vertebral fractures. Bone 1993;14:S89–97.

    Google Scholar 

  3. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ III. Classification of vertebral fractures. J Bone Miner Res 1991;6:207–13.

    Google Scholar 

  4. Ettinger B, Black DM, Nevitt MC, et al. Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner Res 1992;7:449–56.

    Google Scholar 

  5. Ross PD, Ettinger B, Davis J, Melton LJ, Wasnich RD. Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporosis Int 1991;1:134–40.

    Google Scholar 

  6. Spector TD, McCloskey EV, Doyle DV, Kanis JA. Prevalence of vertebral fracture in women and the relationship with bone density and symptoms. J Bone Miner Res 1993;8:817–22.

    Google Scholar 

  7. Zetterburg C, Mannius S, Mellstrom D, Rundgren A, Astrand K. Osteoporosis and back pain in the elderly. Spine 1990;15:783–6.

    Google Scholar 

  8. Orwoll ES, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 1990;70:1202–7.

    Google Scholar 

  9. Reid IR, Evans MC, Ames R, Wattie DJ. The influence of osteophytes and aortic calcification on spinal mineral display in postmenopausal women. J Clin Endocronol Metab 1991 ;72:1372–4.

    Google Scholar 

  10. Masud T, Langley S, Wiltshire P, et al. Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ 1993;307:172–3.

    Google Scholar 

  11. Jones G, Nguyen T, Sambrook PN, et al. A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 1995;22:921–5.

    Google Scholar 

  12. Simons LA, McCallum J, Simons J, et al. The Dubbo study: an Australian prospective community study of the health of elderly. Aust NZ J Med 1990;20:783–9.

    Google Scholar 

  13. Nguyen T, Sambrook P, Kelly PJ, et al. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993;307:1111–5.

    Google Scholar 

  14. Jones G, Nguyen T, Sambrook PN, et al. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporosis Int 1994;4:277–82.

    Google Scholar 

  15. Lord SR, Sambrook PN, Gilbert C, et al. Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust 1994;160:684–91.

    Google Scholar 

  16. Jones G, Nguyen T, Sambrook P, et al. Progressive femoral neck bone loss in the elderly: longitudinal findings from the Dubbo Osteoporosis Epidemiology Study. BMJ 1994;309:691–5.

    Google Scholar 

  17. Nguyen T, Kelly PJ, Sambrook PN, et al. Interaction of lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 1994;9:1339–46.

    Google Scholar 

  18. National Osteoporosis Foundation Working Group. Report: assessing vertebral fractures. J Bone Miner Res 1995;10:518–23.

    Google Scholar 

  19. Pogrund H, Makin M, Robin G, Menczel J, Steinberg R. Osteoporosis in patients with fractured femoral neck in Jerusalem. Clin Orthop 1977;124:165–72.

    Google Scholar 

  20. Harma M, Heliovaara M, Aromaa A, Knekt P. Thoracic spine compression fractures in Finland. Clin Orthop 1986;205:188–94.

    Google Scholar 

  21. O'Neill TW, Varlow J, Felsenberg D, Silman AJ. Sex and geographic influences on the prevalence of vertebral deformity [abstract], J Bone Miner Res 1994;8(Suppl 1):B166.

    Google Scholar 

  22. Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, MN, 1985–1989. J Bone Miner Res 1992;7:221–7.

    Google Scholar 

  23. Dequeker J. The relationship between osteoporosis and osteoarthritis. Clin Rheum Dis 1985;11:271–95.

    Google Scholar 

Download references

Author information

Author notes

  1. G. Jones

    Present address: Menzies Centre for Population Health Research, GPO Box 252C, 7001, Hobart, Tasmania, Australia

Authors and Affiliations

  1. Bone and Mineral Division, Garvan Institute of Medical Research, St. Vincent's Hospital, 384 Victoria Street, 2010, Sydney, NSW, Australia

    G. Jones, C. White, T. Nguyen,  P. N. Sambrook, P. J. Kelly & J. A. Eisman

Authors
  1. G. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. N. Sambrook
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. J. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. A. Eisman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jones, G., White, C., Nguyen, T. et al. Prevalent vertebral deformities: Relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporosis Int 6, 233–239 (1996). https://doi.org/10.1007/BF01622740

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01622740

Keywords

Search

Navigation