Abstract
Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was − 1.4 and mean total hip T-scores was − 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40–49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.
Highlights
Osteoporosis is one of the most common diseases worldwide resulting in millions of fragility fractures each year. 50% of women and 20–25% of men over the age of 50 years will experience an osteoporosis-related fracture, which are associated with significant morbidity, healthcare costs and increased mortality [1,2,3]
The majority of men and women had a prior fracture and a substantial proportion were taking corticosteroids, had rheumatoid arthritis, a family history of osteoporosis or another illness or medication predisposing to osteoporosis (Table 1)
We do not have clinical information on the presence or absence of back pain or other symptoms in this dataset. These results suggest the spine is the commonest site of fracture in this population, which is underrepresented in published data for our country [29, 33]. 70% of people in this study did not have a dual-energy X-ray absorptiometry (DXA) T-score below the osteoporosis threshold
Summary
Osteoporosis is one of the most common diseases worldwide resulting in millions of fragility fractures each year. 50% of women and 20–25% of men over the age of 50 years will experience an osteoporosis-related fracture, which are associated with significant morbidity, healthcare costs and increased mortality [1,2,3]. Epidemiologic studies of VF are heterogeneous, varying within and across different regions [6, 11,12,13,14,15,16] Their prevalence is broadly similar to hip fractures rising exponentially with age [6, 10, 13], in both men and women [6, 10,11,12, 17]. Their illness burden for patients and healthcare systems is similar, but greater than. Specific populations are at increased risk including those with rheumatic diseases [20,21,22,23], taking glucocorticoid therapy [24,25,26,27,28] or with previous fractures [13, 29,30,31]
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