Prevalence of vertebral fracture in oldest old nursing home residents

Summary

We evaluated vertebral fracture prevalence using DXA-based vertebral fracture assessment and its influence on the Fracture Risk Assessment (FRAX) tool-determined 10-year fracture probability in a cohort of oldest old nursing home residents. More than one third of the subjects had prevalent vertebral fracture and 50% osteoporosis. Probably in relation with the prevailing influence of age and medical history of fracture, adding these information into FRAX did not markedly modify fracture probability.

Introduction

Oldest old nursing home residents are at very high risk of fracture. The prevalence of vertebral fracture in this specific population and its influence on fracture probability using the FRAX tool are not known.

Methods

Using a mobile DXA osteodensitometer, we studied the prevalence of vertebral fracture, as assessed by vertebral fracture assessment program, of osteoporosis and of sarcopenia in 151 nursing home residents. Ten-year fracture probability was calculated using appropriately calibrated FRAX tool.

Results

Vertebral fractures were detected in 36% of oldest old nursing home residents (mean age, 85.9?±?0.6?years). The prevalence of osteoporosis and sarcopenia was 52% and 22%, respectively. Ten-year fracture probability as assessed by FRAX tool was 27% and 15% for major fracture and hip fracture, respectively. Adding BMD or VFA values did not significantly modify it.

Conclusion

In oldest old nursing home residents, osteoporosis and vertebral fracture were frequently detected. Ten-year fracture probability appeared to be mainly determined by age and clinical risk factors obtained by medical history, rather than by BMD or vertebral fracture.     

Femoral neck bone mineral density and 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50?years and older

Summary

This study explored the epidemiology of osteoporosis in Bulgarian women (>50?years). Of the women included in the study, 16.8% had osteoporosis and 46.5% had osteopenia at the femoral neck. The mean 10-year absolute fracture risk was 13.4?±?9.2% (major fractures) and 2.8?±?5.2% (hip fractures). This study is the largest Bulgarian epidemiological osteoporosis trial.

Purpose

The aim of this study was to determine the prevalence of the major risk factors for osteoporosis and the 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50 and older.

Methods

This work is a part of the Bulgarian Osteoporosis Epidemiology Study. The National Statistical Institute selected a national representative epidemiological sample. A questionnaire was used allowing fracture risk calculation according to FRAX. Ten osteoporosis centers throughout the country participated. Bone mineral density (BMD) was measured at the femoral neck by dual X-ray absorptiometry. The statistical analysis was performed on a SPSS 13.0 for windows platform.

Results

A total of 1,331 women were included (mean age 63.8?±?8.3?years), divided into decades. Of them, 16.8% had osteoporosis and 46.5% had low femoral neck BMD. Their mean 10-year absolute fracture risk for major fractures was 13.4?±?9.2%, and for hip fractures 2.8?±?5.2%, respectively. The prevalence of some major risk factors for osteoporosis was as follows: height loss?>?3?cm??33.1% of all women; family history of hip fractures??4.1%; previous hip fractures??1.9%; previous vertebral fractures??2.3%; all fractures??23.3%; smoking??11.9%.

Conclusions

This study is the largest epidemiological osteoporosis trial in Bulgaria to date and allows assumptions about the prevalence of osteoporosis and fractures among women aged 50 and older in our country.     

Ethnic difference of clinical vertebral fracture risk

Summary

Vertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. This study observed that Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians, but the vertebral fracture rates were higher, resulting in a high vertebral-to-hip fracture ratio. As a result, estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.

Introduction

Vertebral fractures are the most common osteoporotic fractures. Data on the vertebral fracture risk in Asia remain sparse. The aim of this study was to report the incidence of clinical vertebral fractures among the Chinese and to compare the vertebral-to-hip fracture risk to other ethnic groups.

Methods

Four thousand, three hundred eighty-six community-dwelling Southern Chinese subjects (2,302 women and 1,810 men) aged 50 or above were recruited in the Hong Kong Osteoporosis Study since 1995. Baseline demographic characteristics and medical history were obtained. Subjects were followed annually for fracture outcomes with a structured questionnaire and verified by the computerized patient information system of the Hospital Authority of the Hong Kong Government. Only non-traumatic incident hip fractures and clinical vertebral fractures that received medical attention were included in the analysis. The incidence rates of clinical vertebral fractures and hip fractures were determined and compared to the published data of Swedish Caucasian and Japanese populations.

Results

The mean age at baseline was 62?±?8.2?years for women and 68?±?10.3?years for men. The average duration of follow-up was 4.0?±?2.8 (range, 1 to 14) years for a total of 14,733 person-years for the whole cohort. The incidence rate for vertebral fracture was 194/100,000 person-years in men and 508/100,000 person-years in women, respectively. For subjects above the age of 65, the clinical vertebral fracture and hip fracture rates were 299/100,000 and 332/100,000 person-years, respectively, in men, and 594/100,000 and 379/100,000 person-years, respectively, in women. Hong Kong Chinese and Japanese populations have a less dramatic increase in hip fracture rates associated with age than Caucasians. At the age of 65 or above, the hip fracture rates for Asian (Hong Kong Chinese and Japanese) men and women were less than half of that in Caucasians, but the vertebral fracture rate was higher in Asians, resulting in a high vertebral-to-hip fracture ratio.

Conclusions

The incidences of vertebral and hip fractures, as well as the vertebral-to-hip fracture ratios vary in Asians and Caucasians. Estimation of the absolute fracture risk for Asians may need to be readjusted for the higher clinical vertebral fracture rate.     

Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture

Summary

This study evaluated the characteristics of patients with vertebral fractures and examined the discriminative ability of clinical risk factors. The findings provide further insights into possible development of a simple, cost-effective scheme for fracture risk assessment using clinical risk factors to identify high-risk patients for further evaluation.

Introduction

Vertebral fractures are the most common complication of osteoporosis. The aim of this study was to evaluate the characteristics of patients with vertebral fractures and to determine the discriminative ability of bone mineral density (BMD) and other clinical risk factors.

Methods

Postmenopausal Southern Chinese women (2,178) enrolled in the Hong Kong Osteoporosis Study since 1995 were prospectively followed up for fracture outcome. Subjects (1,372) with lateral spine radiographs were included in this study. Baseline demographic, BMD, and clinical risk factor information were obtained from a structured questionnaire.

Results

Subjects (299; 22%) had prevalent vertebral fractures. The prevalence of vertebral fractures increased with increasing age, number of clinical risk factors, and decreasing BMD. The odds of having a prevalent vertebral fracture per SD reduction in BMD after adjustment for age in Hong Kong Southern Chinese postmenopausal women was 1.5 for the lumbar spine and femoral neck. Analysis of the receiver operating characteristic curve revealed that bone mineral apparent density did not enhance fracture risk prediction. Subjects with ≥4 clinical risk factors had 2.3-fold higher odds of having a prevalent vertebral fracture while subjects with ≥4 clinical risk factors plus a low BMD (i.e., femoral neck T-score <?2.5) had 2.6-fold. Addition of BMD to clinical risk factors did not enhance the discriminative ability to identify subjects with vertebral fracture.

Conclusions

Based on these findings, we recommend that screening efforts should focus on older postmenopausal women with multiple risk factors to identify women who are likely to have a prevalent vertebral fracture.     

Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial

Summary

In the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6?Months (FREEDOM) study, women with incident clinical fractures reported significant declines in health-related quality of life (HRQoL). The largest declines were observed when the assessment was <3?months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain.

Introduction

In the FREEDOM trial, denosumab significantly reduced the risk of new vertebral, hip, and nonvertebral fractures. We evaluated the effect of denosumab on HRQoL and the association between incident clinical fractures and HRQoL.

Methods

The FREEDOM trial enrolled 7,868 women aged 60–90?years with a total hip and/or lumbar spine BMD T-score <?2.5 and not <?4.0 at either site. Women were randomized to receive denosumab 60?mg or placebo every 6?months, in addition to daily calcium and vitamin D. HRQoL was assessed with the Osteoporosis Assessment Questionnaire-Short Version (OPAQ-SV) at baseline and every 6?months for 36?months. The OPAQ-SV assesses physical function, emotional status, and back pain. Higher scores indicate better health status.

Results

No statistically significant differences in mean change in HRQoL from baseline to end of study were found when comparing treatment groups. Compared with women without any incident fractures during the study, women with incident clinical fractures reported significant declines in physical function (?4.0 vs. ?0.5) and emotional status (?5.0 vs. ?0.8) at month?36 (P?<?0.001 for both). Importantly, time-dependent covariate analyses demonstrated that the largest declines were observed when the assessment was <3?months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain.

Conclusions

These findings not only demonstrate that incident clinical fractures impact HRQoL but also contribute new information regarding the impact of these fracture events on HRQoL over time.     

Polymorphisms in the ALOX12 gene and osteoporosis

Summary

ALOX12 produces ligands for PPAR?? thereby turning mesenchymal stem cells into adipocytes instead of osteoblasts. We investigated the effect of polymorphisms in the ALOX12 gene on BMD and fracture risk in two Danish cohorts and found four polymorphisms and a haplotype thereof to be associated with BMD and fracture risk.

Introduction

Stimulation of the PPAR?? with ligands produced by the ALOX enzymes drives mesenchymal stem cells in an adipocyte direction at the expense of osteoblasts leading to decreased osteoblast number and BMD. Previously, polymorphisms in the ALOX12 gene have been associated with osteoporosis.

Methods

We examined the effect of ALOX12 polymorphisms on BMD and the risk of fractures in two Danish cohorts: AROS, a case?Ccontrol population comprising 809 individuals and DOPS, a population comprising 1,716 perimenopausal women allocated to hormone therapy or not at baseline and followed for up to 10?years. On the basis of linkage disequilibrium (LD) between SNPs throughout the gene and previous genetic association studies we chose ten polymorphisms for investigation. Genotyping was carried out using the Sequenom MassARRAY genotyping system and TaqMan assays.

Results

In AROS, individuals heterozygous for the polymorphisms rs3840880, rs9897850, rs2292350 and rs1126667 had a 3.0?C4.7% decreased lumbar spine BMD (p?=?0.02?C0.06) and an increased risk of vertebral fractures (p?<?0.05) compared with individuals homozygous for either allele. In DOPS, none of the individual SNPs were associated with BMD or incident fractures. In both cohorts, the above-mentioned SNPs comprised an LD-block (pairwise D???=?1.0, r ²?=?0.45?C0.97). A haplotype comprising all the common alleles (frequency 9%) was associated with decreased bone loss at the hip (p?<?0.05) and decreased incidence of osteoporotic fractures (p?<?0.05) in DOPS and increased femoral neck BMD in AROS (p?<?0.05).

Conclusion

Our study suggests that genetic variants in ALOX12 may influence BMD and fracture risk.     

Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis

Summary

Vertebral fractures are a major adverse consequence of osteoporosis. In a large placebo-controlled trial in postmenopausal women with osteoporosis, strontium ranelate reduced vertebral fracture risk by 33% over 4 years, confirming the role of strontium ranelate as an effective long-term treatment in osteoporosis.

Introduction

Osteoporotic vertebral fractures are associated with increased mortality, morbidity, and loss of quality-of-life (QoL). Strontium ranelate (2 g/day) was shown to prevent bone loss, increase bone strength, and reduce vertebral and peripheral fractures. The preplanned aim of this study was to evaluate long-term efficacy and safety of strontium ranelate.

Methods

A total of 1,649 postmenopausal osteoporotic women were randomized to strontium ranelate or placebo for 4 years, followed by a 1-year treatment-switch period for half of the patients. Primary efficacy criterion was incidence of patients with new vertebral fractures over 4 years. Lumbar bone mineral density (BMD) and QoL were also evaluated.

Results

Over 4 years, risk of vertebral fracture was reduced by 33% with strontium ranelate (risk reduction?=?0.67, p?<?0.001). Among patients with two or more prevalent vertebral fractures, risk reduction was 36% (p?<?0.001). QoL, assessed by the QUALIOST®, was significantly better (p?=?0.025), and patients without back pain were greater (p?=?0.005) with strontium ranelate than placebo over 4 years. Lumbar BMD increased over 5 years in patients who continued with strontium ranelate, while it decreased in patients who switched to placebo. Emergent adverse events were similar between groups.

Conclusion

In this 4- and 5-year study, strontium ranelate is an effective and safe treatment for long-term treatment of osteoporosis in postmenopausal women.     

Maintenance of antifracture efficacy over 10?years with strontium ranelate in postmenopausal osteoporosis

Summary

In an open-label extension study, BMD increased continuously with strontium ranelate over 10?years in osteoporotic women (P?P?Introduction Strontium ranelate has proven efficacy against vertebral and nonvertebral fractures, including hip, over 5?years in postmenopausal osteoporosis. We explored long-term efficacy and safety of strontium ranelate over 10?years.

Methods

Postmenopausal osteoporotic women participating in the double-blind, placebo-controlled phase 3 studies SOTI and TROPOS to 5?years were invited to enter a 5-year open-label extension, during which they received strontium ranelate 2?g/day (n?=?237, 10-year population). Bone mineral density (BMD) and fracture incidence were recorded, and FRAX? scores were calculated. The effect of strontium ranelate on fracture incidence was evaluated by comparison with a FRAX?-matched placebo group identified in the TROPOS placebo arm.

Results

The patients in the 10-year population had baseline characteristics comparable to those of the total SOTI/TROPOS population. Over 10?years, lumbar BMD increased continuously and significantly (P?P?Conclusions Long-term treatment with strontium ranelate is associated with sustained increases in BMD over 10?years, with a good safety profile. Our results also support the maintenance of antifracture efficacy over 10?years with strontium ranelate.     

Vertebral fracture assessment scans enhance targeting of investigations and treatment within a fracture risk assessment pathway

Summary

Vertebral fracture assessment (VFA) scanning is a useful tool to aid vertebral fracture identification. In this evaluation, we show that introduction of a comprehensive fracture risk assessment pathway incorporating VFA has enhanced diagnosis of vertebral fractures and improved targeting of investigations and treatment.

Introduction

Vertebral fractures are a common manifestation of osteoporosis and are associated with an increased risk of future vertebral and non-vertebral fractures. VFA is a method of imaging the thoraco-lumbar spine and a useful tool to aid vertebral fracture identification. In August 2008, a new one-stop pathway was introduced incorporating VFA and laboratory investigations at the time of bone mineral density assessment. The aims of this evaluation were to evaluate the clinical utility of VFA in identifying vertebral fractures which had not presented clinically and to evaluate the impact of this on management.

Methods

We performed a retrospective 6-month review of the new pathway focussing on those patients undergoing VFA who were suspected to have a vertebral fracture. The outcomes of VFA, spinal X-rays and investigations were evaluated.

Results

Three thousand five hundred twenty-six individuals underwent fracture risk assessment over a 6-month period, of which1,833 underwent VFA. Previously undiagnosed vertebral fractures were found in 202 individuals (36 were in retrospect apparent on prior imaging, and 29 were new vertebral fractures in patients with pre-existing vertebral fractures). Diagnosis of a vertebral fracture led to further investigation in all individuals and altered management in 59 (29 %) individuals. A potentially modifiable underlying cause was found in 42 (21 %).

Conclusions

Introduction of a fracture risk assessment service incorporating VFA and a one-stop pathway has enhanced vertebral fracture identification and targeting of treatment and management.     

Severity of aortic calcification is positively associated with vertebral fracture in older men—a densitometry study in the STRAMBO cohort

Summary

In older men, severe abdominal aortic calcification and vertebral fracture (both assessed using dual-energy X-ray absorptiometry) were positively associated after adjustment for confounders including bone mineral density.

Introduction

Abdominal aortic calcification (AAC) is associated with higher fracture risk, independently of low bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) can be used to assess both vertebral fracture and AAC and requires less time, cost, and radiation exposure.

Methods

We conducted a cross-sectional study of the association between AAC and prevalent vertebral fractures in 901 men ≥50 years old. We used DXA (vertebral fracture assessment) to evaluate BMD, vertebral fracture, and AAC.

Results

Prevalence of vertebral fracture was 11 %. Median AAC score was 1 and 12 % of men had AAC score >6. After adjustment for age, weight, femoral neck BMD, smoking, ischemic heart disease, diabetes, and hypertension, AAC score >6 (vs ≤6) was associated with 2.5 (95 % CI, 1.4–4.5) higher odds of vertebral fracture. Odds of vertebral fracture for AAC score >6 increased with vertebral fracture severity (grade 1, OR?=?1.8; grade 2, OR?=?2.4; grade 3, OR?=?4.4; trend p?<?0.01) and with the number of vertebral fractures (1 fracture, OR?=?2.0, >1 fracture, OR?=?3.5). Prevalence of vertebral fracture was twice as high in men having both a T-score?<??2.0 and an AAC score?>?6 compared with men having only one of these characteristics.

Conclusions

Men with greater severity AAC had greater severity and greater number of vertebral fractures, independently of BMD and co-morbidities. DXA can be used to assess vertebral fracture and AAC. It can provide a rapid, safe, and less expensive alternative to radiography. DXA may be an important clinical tool to identify men at high risk of adverse outcomes from osteoporosis and cardiovascular disease.     

Prevalence of vertebral fractures and quality of life in a sample of postmenopausal Brazilian women with osteoporosis

Summary

The prevalence of vertebral fracture was high in postmenopausal Brazilian osteoporotic women; quality of life was impaired regardless of vertebral fractures, despite a direct correlation between the number of vertebral fractures and a worse quality of life score.

Purpose

The purpose of this study is to evaluate the prevalence of vertebral fractures (VF), quality of life (QOL), association between number of VF and QOL scores, and correlate the factors associated with QOL in a sample of postmenopausal Brazilian women with osteoporosis.

Methods

A cross-sectional study of 126 postmenopausal osteoporotic women aged 55?C80?years was conducted. Women were interviewed about sociodemographic and clinical data, responded to QUALEFFO-41 questionnaire, and underwent vertebral radiography to measure the anterior, mean, and posterior height at each vertebra (T4 to L5). VF were classified as anterior wedge, posterior wedge, central collapse, and crush. Data was expressed as means (±SD) and frequencies, Mann?CWhitney or Student??s T tests were used to compare means, and odds ratio and 95?% confidence interval were used for multiple regression analysis. Values were significant when P value?<?0.05.

Results

The mean age was 65.7?±?6.3?years, age at menopause was 46.5?±?6.8?years and T score of the lumbar spine was ?2.77?±?0.58. The prevalence of VF was 34.1?% (43/126) and the most prevalent type of VF was anterior wedge (45.9?%). There was no difference in QUALEFFO-41 scores between women with and without VF, although there was a direct correlation between QOL scores and number of VF. Factors associated with worse QOL were non-white skin color, obesity, unemployment, sedentary lifestyle, low level of school education, and non-use of osteoporosis drugs.

Conclusion

There was a high prevalence of VF in Brazilian postmenopausal women with osteoporosis. QOL was impaired regardless of VF, despite a direct correlation between number of VF and a worse QOL score.     

Scores on the Safe Functional Motion test predict incident vertebral compression fracture

Summary

The Safe Functional Motion test (SFM) was developed to document movement strategies used to perform everyday activities that may increase the risk for osteoporotic fracture. After adjusting for variables known to predict vertebral compression fracture (VCF), baseline score on the SFM was a significant independent predictor of incident VCF at 1- and 3-year follow-ups.

Introduction

Functional movements may contribute to risk for VCF. We hypothesize that scores on the SFM, a performance-based test of physical function, are associated with incident VCF.

Methods

An osteoporosis clinic database was queried for men and women ≥50 years with an initial SFM and corresponding data for prevalent VCF, history of injurious falls, femoral neck bone mineral density (fnBMD), osteoporosis medication use, and incident morphometric VCF at 1-year (n?=?878) and 3-year follow-ups (n?=?503). Multiple logistic regressions, adjusted for gender, age, injurious fall(s), fnBMD, prevalent VCF at baseline, and osteoporosis medication use, were used to determine whether SFM score was associated with incident VCF at follow-up visits.

Results

Baseline SFM score was a significant independent predictor of incident VCF at 1-year follow-up (adjusted odds ratio (95 % confidence intervals (CI))?=?0.818 (0.707, 0.948); p?<?0.008) and 3-year follow-up (adjusted odds ratio (95 % CI)?=?0.728 (0.628, 0.844); p?<?0.0001). Baseline fnBMD and osteoporosis medication use were significant predictors at 1-year (p?=?0.05 and ?<?0.0001, respectively) and 3-year (p?<?0.01 and 0.001, respectively) follow-ups. At 3-year follow-up, gender and prevalent VCF were also significant predictors (p?=?0.003 and 0.007, respectively).

Conclusions

For every 10-point increase in SFM score, the odds of future VCF decreases by 18 % at 1 year and 27 % at 3 years after adjusting for known covariates. The SFM may aid in the identification of modifiable functional risk factors for VCF.     

Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study

Summary

The use of areal bone mineral density (aBMD) for fracture prediction may be enhanced by considering bone microarchitectural deterioration. Trabecular bone score (TBS) helped in redefining a significant subset of non-osteoporotic women as a higher risk group.

Introduction

TBS is an index of bone microarchitecture. Our goal was to assess the ability of TBS to predict incident fracture.

Methods

TBS was assessed in 560 postmenopausal women from the Os des Femmes de Lyon cohort, who had a lumbar spine (LS) DXA scan (QDR 4500A, Hologic) between years 2000 and 2001. During a mean follow-up of 7.8?±?1.3 years, 94 women sustained 112 fragility fractures.

Results

At the time of baseline DXA scan, women with incident fracture were significantly older (70?±?9 vs. 65?±?8 years) and had a lower LS_aBMD and LS_TBS (both ?0.4SD, p?<?0.001) than women without fracture. The magnitude of fracture prediction was similar for LS_aBMD and LS_TBS (odds ratio [95 % confidence interval]?=?1.4 [1.2;1.7] and 1.6 [1.2;2.0]). After adjustment for age and prevalent fracture, LS_TBS remained predictive of an increased risk of fracture. Yet, its addition to age, prevalent fracture, and LS_aBMD did not reach the level of significance to improve the fracture prediction. When using the WHO classification, 39 % of fractures occurred in osteoporotic women, 46 % in osteopenic women, and 15 % in women with T-score?>??1. Thirty-seven percent of fractures occurred in the lowest quartile of LS_TBS, regardless of BMD. Moreover, 35 % of fractures that occurred in osteopenic women were classified below this LS_TBS threshold.

Conclusion

In conclusion, LS_aBMD and LS_TBS predicted fractures equally well. In our cohort, the addition of LS_TBS to age and LS_aBMD added only limited information on fracture risk prediction. However, using the lowest quartile of LS_TBS helped in redefining a significant subset of non-osteoporotic women as a higher risk group which is important for patient management.     

Reconsideration of the relevance of mild wedge or short vertebral height deformities across a broad age distribution

Summary

Based on an evaluation of vertebral fracture prevalence on lateral radiographs across all age groups in a large cohort, mild or wedge-shaped vertebral body changes identified among adults should be managed as osteoporosis or at least considered as a risk factor for osteoporotic fracture, since they are rare among young subjects.

Introduction

Radiographic assessment of vertebral fractures is limited by the inability to distinguish mild fractures from congenital mild wedge deformities or vertebrae of short vertebral height. We attempted to quantify the expected background prevalence of these deformities by measuring vertebral fracture prevalence across all age groups in a large hospital-based retrospective Chinese cohort.

Methods

We reviewed eligible lateral chest radiographs from patients admitted to Peking Union Medical College Hospital during 2011 using the Genant semiquantitative method for vertebral fracture assessment (T4–L2). We evaluated fracture prevalence among subjects by sex, 10-year age group, and fracture severity grades subjectively. We further analyzed characteristics of subjects with mild (grade I) fractures to estimate the relative contribution of congenital mild wedge deformities.

Results

A total of 10,720 subjects (5,396 men and 5,324 women) with lateral chest radiographs were evaluated. Subjects ranged in age from 0.5 to 97 years with a mean of 51.8?±?17.4 years (men 52.8?±?17.6 years; women 50.8?±?17.2 years). When stratified by 10-year age groups, the prevalence of vertebral fractures was relatively low until about 40 years of age, after which prevalence increased for both genders. Fractures (13 fractures for 9 males and 6 fractures for 5 females) seen in subjects younger than 40 years of age were almost exclusively mild grade fractures. No fractures were identified in subjects younger than 20 years of age.

Conclusions

Mild or wedge-shaped vertebral body changes on lateral radiographs are rare among young subjects, indicating that when mild vertebral deformities are found among adults, they are likely to be the product of aging and not congenital variation. Clinically, therefore, mild vertebral body changes should be managed as osteoporosis or at least considered as a risk factor for osteoporotic fracture.     

Fracture rate and back pain during and after discontinuation of teriparatide: 36-month data from the European Forsteo Observational Study (EFOS)

Summary

In this observational study in postmenopausal women with severe osteoporosis, the incidence of fractures was decreased during 18?months of teriparatide treatment with no evidence of further change in the subsequent 18-month post-teriparatide period when most patients took other osteoporosis medications. Fracture reduction was accompanied by reductions in back pain.

Introduction

To describe fracture outcomes and back pain in postmenopausal women with severe osteoporosis during 18?months of teriparatide treatment and 18?months post-teriparatide in normal clinical practice.

Methods

The European Forsteo Observational Study (EFOS) was a prospective, multinational, observational study. Data on incident clinical fractures and back pain (100?mm Visual Analogue Scale [VAS] and questionnaire) were collected. Fracture data were summarised in 6-month intervals and analysed using logistic regression with repeated measures. Changes from baseline in back pain VAS were analysed using a repeated measures model.

Results

A total of 208 (13.2%) of 1,576 patients sustained 258 fractures during 36?months of follow-up: 34% were clinical vertebral fractures and 66% non-vertebral fractures. The adjusted odds of fracture were reduced during teriparatide treatment and there was no evidence of further change in the 18-month post-teriparatide period, during which 63.3% patients took bisphosphonates. A 74% decrease in the adjusted odds of fracture in the 30- to <36-month period compared with the first 6-month period was observed (p?<?0.001). Back pain decreased during teriparatide treatment and this decrease was sustained after teriparatide discontinuation. Adjusted mean back pain VAS decreased by 26.3?mm after 36?months (p?<?0.001) from baseline mean of 57.8?mm.

Conclusions

In a real-life clinical setting, the risk of fracture decreased during teriparatide treatment, with no evidence of further change after teriparatide was discontinued. The changes in back pain seen during treatment were maintained for at least 18?months after teriparatide discontinuation. These results should be interpreted in the context of the design of an observational study.     

Vertebral body morphology is associated with incident lumbar vertebral fracture in postmenopausal women. The OFELY study

Summary

We investigate the predictive role of vertebral anterior cortical curvature and height heterogeneity in the occurrence of vertebral fractures in postmenopausal women. Women who will fracture had shorter vertebral height, greater heterogeneity of height than those who will not fracture, and their anterior vertebral body edge was less concave.

Introduction

Vertebral morphology has been demonstrated to be associated with further risk of fracture. The aim of this study was to analyze vertebral anterior cortical curvature (Ct.curv) and vertebral height heterogeneity in postmenopausal women before the occurrence of a vertebral fracture.

Methods

This case–control study included 29 postmenopausal women who have underwent incident lumbar vertebral fractures (mean age 71?±?9 years, mean time to fractures 9?±?4 years), age-matched with 57 controls. From lateral X-rays of lumbar spine radiographs (T12 to L4), the following parameters were measured: (1) the posterior, middle, and anterior vertebral heights; (2) the heterogeneity of heights evaluated by the coefficient of variation of these three variables; (3) antero-posterior width, a 2D estimator of cross-sectional area; and (4) Ct.curv.

Results

Mean vertebral heights were significantly lower among women who fractured than in controls (p?<?0.05). The anterior and middle heights were significantly lower at L4 and L3 levels in fracture group (p?=?0.02). The heterogeneity of vertebral height was significantly greater in the fracture group (p?=?0.003). In addition, fractured patients had a significantly higher Ct.curv on L3 (p?=?0.04). After adjustment for bone mineral density (BMD), only the heterogeneity of vertebral height remained significant (p?=?0.005).

Conclusion

The current case–control study confirmed the association between vertebral height and occurrence of future vertebral fracture in postmenopausal women. The vertebrae with the smallest Ct.curv tended to fracture less often, and the heterogeneity of vertebral heights was associated with future fracture independently of BMD. An additional validation in a prospective study would be needed to confirm these initial results.

     

An evaluation of the Fracture Risk Assessment Tool (FRAX®) as an indicator of treatment efficacy: the effects of bazedoxifene and raloxifene on vertebral, nonvertebral, and all clinical fractures as a function of baseline fracture risk assessed by FRAX®

Summary

The relationship between baseline Fracture Risk Assessment Tool (FRAX®) and treatment efficacy was evaluated using data from a pivotal phase 3 study. Relative risk of vertebral, nonvertebral, and all clinical fractures decreased with increasing probability of fracture for bazedoxifene (BZA) versus placebo but remained generally constant for raloxifene (RLX).

Introduction

To determine whether the FRAX® predicts osteoporosis treatment efficacy, we evaluated reductions in fracture incidence associated with BZA and RLX according to baseline fracture risk determined by FRAX® using data from a phase 3 osteoporosis treatment study.

Methods

Hazard ratios (HRs) for effects of BZA and RLX versus placebo on incidence of vertebral, nonvertebral, and all clinical fractures were calculated using a Cox regression model. Cox regression analyses were performed in subgroups at or above 10-year fracture probability thresholds determined by FRAX®.

Results

HRs for the risk of vertebral, nonvertebral, and all clinical fractures versus placebo decreased with increasing 10-year fracture probability for BZA, while those for RLX remained stable. In all 10-year fracture probability subgroups, all BZA doses significantly reduced vertebral fracture risk versus placebo (HR?=?0.22–0.66). BZA at 20, 40, and 20/40 mg significantly reduced risk of nonvertebral fractures (HR?=?0.45, 0.44, and 0.45, respectively) and all clinical fractures (HR?=?0.38, 0.41, and 0.40, respectively) for ≥20.0 % fracture probability. Vertebral fracture risk reductions for RLX 60 mg versus placebo were significant in subgroups at lower fracture probabilities (≥2.5–?≥?10.0 %), but not higher (≥12.5 %), and in no subgroups for nonvertebral or all clinical fractures.

Conclusion

The antifracture efficacy of BZA increased with increasing baseline FRAX® score, but there was no clear relationship between RLX and baseline FRAX®. These findings provide independent confirmation of current literature, suggesting that the relationship between FRAX® and treatment efficacy varies for different agents.     

Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture

Summary

A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended.

Introduction

The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s).

Methods

The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations.

Results

The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training.

Conclusions

The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional.