Vertebral dimensions as risk factor of vertebral fracture in osteoporotic patients: a systematic literature review

Summary This systematic literature review studied the potential association between vertebral fracture risk and vertebral dimensions. Analysis showed that patients with vertebral fractures have smaller non-fractured vertebrae than patients without fractures. Vertebral size is an independent risk factor of vertebral fractures. Introduction Biomechanical factors such as vertebral dimensions may be a risk factor for vertebral fractures beside bone mineral density (BMD). The objective of this study was to evaluate potential association of vertebral size and shape with osteoporotic fracture risk through a systematic literature review. Methods Systematic analysis of published reports comparing vertebral dimensions of patients with and without osteoporotic fractures was performed. Data sources were electronic databases. Data extraction included methods, site, reproducibility and results of vertebral measurement, study population characteristics. It was noted if populations were matched or data were adjusted for age, height, weight and BMD. Results Of 634 reports identified by the literature search, the final review included 13 reports studying 4,428 women and 508 men; median age 64.2 years [range 51.7%–73.0%]. Measurements were performed with computed tomography scan, X-ray, or dual energy X-ray absorptiometry. Vertebral body height, width, depth, area, cross-sectional area (CSA), and volume were 5.5% to 9.5% smaller in fractured group than control group. After adjustment for confounding factors, area, CSA and volume were, respectively, 10.2% [range 7.1%–13.3%], 7.7% [range 1.2%–14.2%] and 9.5% [8.5%–10.5%] smaller in fractured group. Conclusions Vertebral size should be considered as a potential independent vertebral fracture risk factor.