Skip to main content
SpringerLink
Log in

Mild prevalent and incident vertebral fractures are risk factors for new fractures

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

Abstract

Summary

This prospective four-year study indicates that post-menopausal osteoporotic women with mild prevalent and incident vertebral fractures have an increased risk of incident fractures.

Introduction

Mild vertebral fractures are under diagnosed as there is disagreement about their clinical significance. Our aim was to assess the risk of subsequent fractures induced by both prevalent and incident mild vertebral fractures in osteoporotic post-menopausal women.

Patients and methods

Three thousand three hundred and fifty-eight patients, aged 74 ± 6 years, with post-menopausal osteoporosis included in the placebo groups of two clinical trials of strontium ranelate were followed for 4 years. A Cox regression model adjusted on age, body mass index and bone mineral density was used to calculate the relative risk (RR) of fracture in subjects with only mild fractures as compared to patients without fracture, and to patients with at least one grade ≥ 2 fracture. These calculations were made for prevalent and then incident fractures.

Results

The RR of vertebral fracture in 4 years was 1.8 (1.3–2.4) p < 0.001, and 2.7 (2.3–3.3) p < 0.001 for patients having only mild vertebral fractures and at least one grade ≥ 2 fracture at baseline respectively. The RR of vertebral fracture in the 3rd and 4th years of follow-up was 1.7 (1.1–2.6) p = 0.01, and 1.9 (1.3–2.6) p < 0.001 for patients having during the first 2 years incident mild fractures only, and for patients having at least one grade ≥ 2 incident fracture respectively. The RR of non-vertebral fracture in 4 years was 1.3 (0.9–1.9) p = 0.15 and 1.7 (1.4–2.1) p < 0.001 for patients having only mild or at least one grade ≥ 2 vertebral fracture at baseline respectively. For patients aged more than 70 years, these RR were 1.45 (0.99–2.11) (p = 0.06), and 1.72 (1.36–2.18) p < 0.001 respectively. The RR of non-vertebral fracture in the 3rd and 4th years was 1.68 (1.36–2.09) p < 0.001 for patients having at least one grade ≥ 2 incident fracture during the 2 first years of follow-up.

Conclusion

Mild vertebral fractures are a risk factor for subsequent vertebral and non-vertebral fracture in postmenopausal women with osteoporosis; 1 out of 4 patients with an incident mild vertebral fracture in 2 years will fracture again within the 2 next years.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800

    PubMed  CAS  Google Scholar 

  2. Ensrud KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, Santora AC 2nd, Black DM (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. J Am Geriatr Soc 48:241–249

    PubMed  CAS  Google Scholar 

  3. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  PubMed  CAS  Google Scholar 

  4. Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures on health-related quality of life in osteoporotic post-menopausal women. Osteoporos Int 16:2175–2179

    Article  PubMed  CAS  Google Scholar 

  5. Huang C, Ross PD, Washnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475

    Article  PubMed  CAS  Google Scholar 

  6. Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582

    Article  PubMed  CAS  Google Scholar 

  7. Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL; for the IMPACT Study Group (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT Study. J Bone Miner Res 20:557–563

    Article  PubMed  Google Scholar 

  8. Fechtenbaum J, Cropet C, Kolta S, Verdoncq B, Orcel P, Roux C (2005) Reporting of vertebral fractures on spine X-rays. Osteoporos Int 16:1823–1826

    Article  PubMed  CAS  Google Scholar 

  9. Black DM, Palermo L, Nevitt MC, Genant HK, Christensen L, Cummings SR (1999) Defining incident vertebral deformity: a prospective comparison of several approachs. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:90–101

    Article  PubMed  CAS  Google Scholar 

  10. Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456

    PubMed  CAS  Google Scholar 

  11. Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent fractures and the risk of subsequent vertebral and non vertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  12. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    Article  PubMed  CAS  Google Scholar 

  13. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E, Jiang G, Eastell R (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  PubMed  CAS  Google Scholar 

  14. Melton LJ III, Wenger DE, Atkinson EJ, Achenbach SJ, Berquist TH, Riggs BL, Jiang G, Eastell R (2006) Influence of baseline deformity definition on subsequent vertebral fracture risk in post-menopausal women. Osteoporos Int 17:978–985

    Article  PubMed  Google Scholar 

  15. Crans GG, Genant HK, Krege JH (2005) Prognostic utility of a semiquantitative spinal deformity index. Bone 37:175–179

    Article  PubMed  Google Scholar 

  16. Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski J, Spector TD, Cannata J, Balogh A, Lemmel EM, Pors Neilsen S, Rizzoli R, Genant HK, Reginster JY (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468

    Article  PubMed  CAS  Google Scholar 

  17. Reginster JY, Seeman E, de Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Diaz Curiel M, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of non vertebral fractures in post-menopausal women with osteoporosis: TReatment Of Peripheral OSteoporosis (TROPOS) Study. J Clin Endocrinol Metab 90:2816–2822

    Article  PubMed  CAS  Google Scholar 

  18. Roux C, Reginster JY, Fechtenbaum J, Kolta S, Sawicki A, Tulassay Z, Luisetto G, Padrino JM, Doyle D, Prince R, Fardellone P, Sorensen OH, Meunier PH (2006) Vertebral fracture risk reduction with strontium ranelate in women with post-menopausal osteoporosis in independent of baseline risk factors. J Bone Miner Res 21:536–542

    Article  PubMed  CAS  Google Scholar 

  19. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  20. Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 11:984–996

    PubMed  CAS  Google Scholar 

  21. Wu CY, Li J, Jergas M, Genant HK (1995) Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int 5:354–370

    Article  PubMed  CAS  Google Scholar 

  22. Lindsay R, Pack S, Li Z (2005) Longitudinal progression of fracture prevalence through a population of post-menopausal women with osteoporosis. Osteoporos Int 16:306–312

    Article  PubMed  Google Scholar 

  23. Lunt M, O’Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513

    Article  PubMed  Google Scholar 

  24. Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 20:1349–1355

    Article  PubMed  Google Scholar 

  25. Crans GG, Silverman SL, Genant HK, Glass EV, Krege JH (2004) Association of severe vertebral fractures with reduced quality of life. Arthritis Rheum 50:4028–4034

    Article  PubMed  CAS  Google Scholar 

  26. Fink HA, Milavetz DL, Palermo L, Nevitt MC, Cauley JA, Genant HK, Black DM, Ensrud KE; for the Fracture Intervention Trial Research Group (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20:1216–1222

    Article  PubMed  Google Scholar 

  27. Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporosis Int 16:717–728

    Article  CAS  Google Scholar 

  28. Jiang G, Barrington NA, Eastell R, Ferrar L (2004) Visual identification of prevalent vertebral fracture: comparison between methods. Osteoporos Int 15:887–896

    Article  PubMed  CAS  Google Scholar 

  29. Abdul-Hamid Osman A, Bassionni H, Koutri R, Nus J, Geusens P, Dequeker J (1994) Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis-a cross sectional and longitudinal study. Bone 15:437–442

    Article  Google Scholar 

  30. Reeve J, Lunt M, Felsenberg D, Silman AJ, Scheidt-Nave C, Poor G, Gennari C, Weber K, Lorenc R, Masaryk P, Cannata JB, Dequeker J, Reid DM, Pols HA, Benevolenskaya LI, Stepan JJ, Miagowski T, Bhalla A, Bruges Armas J, Eastell R, Lopes-Vaz A, Lyritis G, Jajic I, Woolf AD, Banzer D, Reisinger W, Todd CJ, Felsch B, Havelka S, Hoszowski K, Janott J, Johnell O, Raspe HH, Yershova OB, Kanis JA, Ambrecht G, Finn JD, Gowin W, O’Neill TW; European Prospective Osteoporosis Study Group (2003) Determinants of the size of incident vertebral deformities in European men and women in the sixth to ninth decades of age (EPOS). J Bone Miner Res 18:1664–1673

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Thanks are due to F. Gavini, Statistical Department, Servier, France.

Author information

Authors and Affiliations

  1. Cochin Hospital, Rheumatology Department, University of Paris, 27, rue du Faubourg St Jacques, 75014, Paris, France

    C. Roux, J. Fechtenbaum, S. Kolta & K. Briot

  2. Statistical Department, Servier, France

    M. Girard

Authors
  1. C. Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Fechtenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Kolta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Briot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Girard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Roux.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roux, C., Fechtenbaum, J., Kolta, S. et al. Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18, 1617–1624 (2007). https://doi.org/10.1007/s00198-007-0413-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-007-0413-1

Keywords

Search

Navigation