Prevalent Vertebral Fracture and the Risk of Incident Vertebral Fracture

Abstract

To the Editor: In their study of long-term risk of incident vertebral fractures, Dr Cauley and colleagues concluded that older women with a prevalent vertebral fracture had a substantially increased absolute risk of an incident fracture, particularly if they had osteoporosis diagnosed by bone mineral density assessment. In this study, it appears that both symptomatic and asymptomatic women with a prevalent vertebral fracture at baseline were combined. Only about one-third of vertebral fractures are clinically recognized. Because of this, it would be valuable to know the absolute risk of an incident fracture for symptomatic and asymptomatic women separately. Symptomatic women with a prevalent fracture at baseline may have had more opportunity to receive medication for osteoporosis than asymptomatic women who were diagnosed only by radiographs. This might result in a lower absolute risk of incident fracture among symptomatic women. In addition, the odds ratio (OR) for incident fracture in asymptomatic women with a prevalent fracture at baseline compared with those without a prevalent fracture might be higher than the overall risk reported in the study (OR, 4.21; 95% confidence interval, 3.33-5.34).