Prevalent Vertebral Fractures Research Articles

Simultaneous automated ascertainment of prevalent vertebral fracture and abdominal aortic calcification in clinical practice: role in fracture risk assessment.

Whether simultaneous automated ascertainments of prevalent vertebral fracture (auto-PVFx) and abdominal aortic calcification (auto-AAC) on vertebral fracture assessment (VFA) lateral spine bone density (BMD) images jointly predict incident fractures in routine clinical practice is unclear. We estimated the independent associations of auto-PVFx and auto-AAC primarily with incident major osteoporotic and secondarily with incident hip and any clinical fractures in 11 013 individuals (mean [SD] age 75.8 [6.8] years, 93.3% female) who had a BMD test combined with VFA between March 2010 and December 2017. Auto-PVFx and auto-AAC were ascertained using convolutional neural networks (CNNs). Proportional hazards models were used to estimate the associations of auto-PVFx and auto-AAC with incident fractures over a mean (SD) follow-up of 3.7 (2.2) years, adjusted for each other and other risk factors. At baseline, 17% (n = 1881) had auto-PVFx and 27% (n = 2974) had a high level of auto-AAC (≥ 6 on scale of 0 to 24). Multivariable-adjusted hazard ratios (HR) for incident major osteoporotic fracture (95% C.I.) were 1.85 (1.59, 2.15) for those with compared to those without auto-PVFx, and 1.36 (1.14, 1.62) for those with high compared to low auto-AAC. The multivariable-adjusted HRs for incident hip fracture were 1.62 (95% C.I. 1.26 to 2.07) for those with compared to those without auto-PVFx, and 1.55 (95% C.I. 1.15 to 2.09) for those high auto-AAC compared to low auto-AAC. The 5-year cumulative incidence of major osteoporotic fracture was 7.1% in those with no auto-PVFx and low auto-AAC, 10.1% in those with no auto-PVFx and high auto-AAC, 13.4% in those with auto-PVFx and low auto-AAC, and 18.0% in those with auto-PVFx and high auto-AAC. While physician manual review of images in clinical practice will still be needed to confirm image quality and provide clinical context for interpretation, simultaneous automated ascertainment of auto-PVFx and auto-AAC can aid fracture risk assessment.

Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee.

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others.

Chronic Obstructive Pulmonary Disease as a Significant Marker of Prevalent Vertebral Fracture in Patients with Spinal Degenerative Disease: Preoperative Risk Factors Involved in Lifestyle-Related Diseases

Objectives: It is important to recognize prevalent vertebral fractures before spinal surgery due to the possible complications related to bone fragility. Recently, it has been noted that lifestyle-related diseases are associated with vertebral fractures. In this study, we analyzed prevalent vertebral fractures among patients with spinal degenerative disease and investigated their association with lifestyle-related diseases. Methods: We included patients aged ≥60 years who underwent surgery for spinal degenerative disease between March 2019 and February 2021 at our hospital. The primary outcome measure was radiographically prevalent vertebral fractures from T10 to L5. Univariate analyses were performed for variables obtained from preoperative data related to lifestyle-related diseases between the vertebral fracture and non-fracture groups. Multiple logistic regression was performed with adjustments for variables including patient age, sex, and surgical site, and variables that were found to have a p-value of &lt;0.2 in univariate analyses. Results: A total of 220 patients were enrolled, of which 121 had prevalent vertebral fractures. Multiple logistic analysis was conducted with patient age, sex, and surgical site, and those variables identified p &lt; 0.2 in univariate analyses: eGFR &lt;60 mL/min/1.73 m2 serum uric acid &gt;7.0 mg/dL, FEV1/FVC &lt;70%, and bone mineral density (BMD) T-score &lt;–1.0. Patients with vertebral fractures were significantly older and had lower BMD, and lower FEV1/FVC. Conclusions: Patients with FEV1/FVC &lt;70% characterizing COPD had a significantly higher risk of vertebral fractures, independent of sex, age, and BMD. The risk of postoperative complications related to bone fragility should be considered in patients with COPD.

Low Hounsfield unit values on computed tomography as a potential predictor of vertebral fracture in patients with rheumatoid arthritis: The KURAMA cohort study.

Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention for the detection of osteoporosis. This study aimed to investigate whether opportunistic CT could predict vertebral fractures in patients with rheumatoid arthritis (RA). A total of 233 patients with RA who underwent chest CT were included in this study. The HU values of the anterior 1/3 of the vertebral bodies based on the sagittal plane at T11-L2 after reconstruction were measured. The incidence of vertebral fractures was investigated with respect to the HU value. Vertebral fractures were identified in 32 patients during a mean follow-up period of 3.8 years. In patients who experienced vertebral fractures within 2 years of CT imaging, the HU values of the vertebral bodies (T11-L2) were lower than those in patients who did not experience fractures. Receiver operating characteristic curve analysis identified that a T11 HU value of <125 was a risk factor for vertebral fracture within 2 years. Multivariate analysis showed that a T11 HU value of <125 and the existence of prevalent vertebral fractures were significant risk factors for fracture. HU measurements of the anterior 1/3 of the vertebral body are a potential predictor for vertebral fractures in patients with RA.

The yield of routine laboratory examination in osteoporosis evaluation in primary care

SummaryThis study evaluated the yield of routine laboratory examination in a large population of older women in primary care. The prevalence of laboratory abnormalities was low and the clinical consequences in follow-up were limited. There was a weak association of laboratory abnormalities with osteoporosis but no association with vertebral fractures and recent fractures.PurposeMost osteoporosis guidelines advice routine laboratory examination. We have investigated the yield of laboratory examinations in facture risk evaluation of elderly women in primary care.MethodsWe assessed the prevalence of laboratory abnormalities and their association with risk factors for fractures, recent fractures, low bone mineral density (BMD), and prevalent vertebral fracture in 8996 women ≥ 65 years of age participating in a primary care fracture risk screening study. In a sample of 2208 of these participants, we also evaluated the medical consequences in the medical records during a follow-up period of ≥ 1 year.ResultsVitamin D deficiency (< 30 nmol/L) was present in 13% and insufficiency (< 50 nmol/L) in 43% of the study sample. The prevalence of other laboratory abnormalities (ESR, calcium, creatinine, FT4) was 4.6% in women with risk factors for fractures, 6.1% in women with low BMD (T-score ≤  − 2.5), 6.0% after a prevalent vertebral fracture, 5.2% after a recent fracture and 2.6% in the absence of important risk factors for fractures. Laboratory abnormalities other than vitamin D were associated with low BMD (OR 1.4, 95%CI 1.1–1.8) but not with prevalent vertebral fractures nor recent fractures. Low BMD was associated with renal failure (OR 2.0, 95%CI 1.3–3.4), vitamin D insufficiency (OR 1.2, 95%CI 1.0–1.3) and deficiency (OR 1.3, 95%CI 1.1–.5). In the follow-up period, 82% of the laboratory abnormalities did not result in a new diagnosis or treatment reported in the medical records.ConclusionsWe identified a low prevalence of laboratory abnormalities in a primary care population of older women and the majority of these findings had no medical consequences.

Prevalence and prognostic impact of bone disease in chronic heart failure with reduced ejection fraction.

Chronic heart failure is associated with a bone-catabolic state and increases the risk of osteoporosis and fractures. Prospective studies investigating the clinical relevance of bone disease in heart failure are lacking. We aimed to assess the prevalence and prognostic impact of osteoporosis and vertebral fractures (VFs) in chronic heart failure with reduced ejection fraction (HFrEF). Symptomatic outpatients with chronic heart failure and a previous diagnosis of overtly reduced left ventricular ejection fraction<40% on stable, optimal HFrEF therapy and left ventricular ejection fraction<50% at enrolment were included into a prospective single-centre study. Osteoporosis was determined with dual-energy X-ray absorptiometry and defined as a T-score≤2.5 at any site. VFs were assessed using X-ray of both thoracic and lumbar spine applying the semiquantitative Genant score. We enrolled 205 patients (22% women), with a median age of 66 (IQR 58-74) years. Median left ventricular ejection fraction was 37 (IQR 30-43) % and median N-terminal pro B-type natriuretic peptide was 964 (IQR 363-2173) pg/mL. Osteoporosis, as defined by bone mineral density, and at least one VF were prevalent in 31 (15%) and 29 patients (14%). Osteoporosis or VF were present in 55 patients (27%) and 5 patients (2%) had both osteoporosis and a VF. During a median follow-up of 4.7 (IQR 4.0-5.3) years, 18 patients (9%) died due to cardiovascular (CV) cause, and 46 patients (22%) had a worsening heart failure (WHF) hospitalization. In multivariate Cox regression analyses, presence of VF independently predicted CV death (HR 2.82, 95% CI 1.04-7.65, P=0.042), WHF hospitalizations (HR 2.39, 95% CI 1.18-4.82, P=0.015), and a composite endpoint of CV death and WHF hospitalizations (HR 2.44, 95% CI 1.23-4.82, P=0.011). Osteoporosis was not significantly associated with CV events. In a prospective study, bone disease affected every fourth patient with HFrEF, and patients with VF at baseline had a two-fold risk of subsequent CV death or WHF hospitalization. Prevalent bone disease, particularly VF, should be considered as a clinically relevant comorbidity in HFrEF.

Analysis of factors related to osteoporotic vertebral fracture in prostate cancer patients

ObjectiveThis study was aimed at exploring the osteoporotic vertebral fracture rate and the related causal factors in prostate cancer patients before and after treatment.MethodsOne hundred prostate cancer patients were recruited in this study. One hundred men without prostate cancer history were selected as the control group. The study was approved by the Medical Ethics Committee under Ethics number B2021-373R and the requirement for the informed consent was waived. The T4-L1 vertebral body of the case group and the control group before and after treatment was evaluated according to Genant’s semi-quantitative method. The difference in vertebral body fracture rate between the case group and the control group and the changes in vertebral body fracture rate before and after treatment among the case group were compared. They were grouped according to age, body mass index (BMI), prostate-specific antigen (PSA) levels, Gleason grade, and androgen deprivation therapy (ADT). Univariate and multivariate logistic regression models were used to determine the factors significantly associated with vertebral fracture rate in prostate cancer patients.ResultsThe prevalence of vertebral fracture was 16% and 31% in prostate cancer patients before and after treatment, respectively, and 29% in the control group. The vertebral fracture rate of the patients before treatment significantly differed that of the control group and the patients after treatment. Univariate analysis showed that age, PSA levels, and treatment parameters were the significant influencing factors of vertebral fracture rates. Multivariate logistic regression analysis showed that age was the main influencing factor of vertebral fracture rates.ConclusionOsteoporotic vertebral fractures in patients with prostate cancer was associated with many factors. And the incidence of vertebral fracture in prostate cancer patients after ADT was significantly higher than that before treatment.

Physical performance and sarcopenia assessment in patients with a recent fracture visiting the Fracture Liaison Service

SummaryImpaired physical performance is associated with increased fracture risk. Performance on four physical functioning tests and prevalence of sarcopenia were assessed for 1789 fracture patients and compared to reference data. Performance was low on all tests, especially for patients with a hip, major or ≥ 1 prevalent vertebral fracture.Purpose IntroductionImpaired physical performance and sarcopenia are associated with increased fracture risk. This study aims to assess physical performance and the prevalence of sarcopenia in patients with a recent clinical fracture attending the Fracture Liaison Service (FLS) compared to population means.MethodsIn this cross-sectional study, chair stand test (CST), handgrip strength (HGS), timed-up-and-go (TUG), 6-min walking-test (6MWT), and sarcopenia (following EWGSOP2) were assessed. The proportion of patients with impaired/poor performance compared to reference data was calculated (Z-score: ≥  − 2SD to <  − 1 (impaired) and <  − 2 SD (poor)). Associations of fracture type, sex, age, and time since fracture with Z-scores were assessed using linear regression analyses.ResultsA total of 1789 consecutive FLS patients were included (median age (IQR): 66 (59–74), 70.7% females, 3.9 (± 1.6) months after fracture). The prevalence of impaired/poor performance for CST, HGS, TUG, and 6MWT was 39.2%, 30.4%, 21.9%, and 71.5%, respectively (expected proportion of 16%) and 2.8% had sarcopenia. Lower Z-scores (P < 0.001) were found for hip, major, and ≥ 1 prevalent vertebral fracture (VF) in CST (major: regression coefficient (B) (95%CI) =  − 0.25 [− 0.34, − 0.16]; hip: B =  − 0.32 [− 0.47, − 0.17], VF: B =  − 0.22 [− 0.34, − 0.11]), TUG; (major: B =  − 0.54 [− 0.75, − 0.33]; hip: B =  − 1.72 [− 2.08, -1.35], VF: B =  − 0.61 [− 0.88, − 0.57]), 6MWT (major: B =  − 0.34 [− 0.47, − 0.21]; hip: B =  − 0.99 [− 1,22, − 0.77], VF: B =  − 0.36 [− 0.53, − 0.19]).ConclusionsPhysical performance is significantly lower in FLS patients compared to healthy peers, especially in patients with hip, major or prevalent VF. These findings underline the need to assess and improve the physical performance of FLS patients, despite a low prevalence of sarcopenia.

Progression of vertebral deformity of prevalent vertebral fractures in the elderly: a population-based study

BackgroundLittle is known about the progression pattern of vertebral deformities in elderly patients with prevalent vertebral fractures. This population-based cohort study investigated the incidence, progression pattern, and risk factors of vertebral deformity in prevalent vertebral fractures over a finite period of four years in a population-based cohort study.MethodsA total of 224 inhabitants of a typical mountain village underwent medical examinations every second year from 1997 to 2009, and each participant was followed up for four years. The extent (mild, moderate, severe) and type (wedge, biconcave, crush) of prevalent vertebral fractures on spinal radiographs were evaluated using the Genant semi-quantitative method. Of these participants, 116 with prevalent vertebral fractures at baseline (32 men and 84 women; mean age: 70.0 years) were included in this study. The progression patterns of the 187 vertebral fractures with mild and moderate deformities (except severe deformity) were evaluated. Logistic regression analysis was used to identify the risk factors associated with deformity progression.ResultsThe progression of vertebral deformities was identified in 13.4% (25 vertebral fractures) of the total 187 prevalent (mild and moderate) vertebral fracture deformities over four years. Among the three deformity types, the prevalence of deformity progression was significantly lower in wedge-type vertebral fractures (P < 0.05). Age and number of prevalent vertebral fractures per participant were independent risk factors associated with the progression of prevalent vertebral deformities.ConclusionThis study clarified the natural history of the progression pattern of vertebral deformities in radiographic prevalent vertebral fractures in elderly individuals. Multiple vertebral fractures in the elderly present a risk for the progression of vertebral deformities.

Trends in prevalence of fractures among adults in the United States, 1999-2020: a population-based study.

Population data that examines recent national trends in the prevalence of fractures are lacking in the United States (US). Analyses were based on 1999-2020 data from the National Health and Nutrition Examination Survey (NHANES). Primary outcomes included the prevalence of hip, wrist, and vertebral fractures among adults aged greater than or equal to 50 years. Changes in the prevalence over time were determined by joinpoint regression analysis. The authors also described the variation by fracture subtypes, sociodemographic characteristics, and their combination. For adults aged greater than or equal to 50 years in NHANES 2017-March 2020, the authors estimated that there was 2.6 million Americans with hip fractures, 14.6 million Americans with wrist fractures, and 5.2 million Americans with vertebral fractures. The prevalence of wrist fractures significantly increased from 8.7% (7.4-9.9%) in 1999-2000 to 12.8% (11.6-14.1%) in 2017-March 2020 among adults aged greater than or equal to 50 years ( P for trend=0.04); significant increases were also observed in fractures that occurred at age less than 50 years, non-Hispanic White, high family income groups, and several combination subgroups (e.g. fractures occurred at age <50 years among women). The prevalence of vertebral fractures increased from 2.2% (1.7-2.8%) in 1999-2000 to 4.6% (3.7-5.5%) in 2017-March 2020 among adults aged greater than or equal to 50 years ( P for trend=0.02); significant increases were also observed in 50-64 years, women, non-Hispanic White, high family income groups and several combination subgroups (e.g. fractures that occurred at age <50 years among women). The authors did not observe significant trend changes in the prevalence of hip fractures among adults aged greater than or equal to 50 years between 1999 and 2020. The estimated prevalence of wrist and vertebral fractures significantly increased among US adults aged greater than or equal to 50 years from 1999 to 2020, although hip fractures did not significantly change.

Prevalence of Morphometric Vertebral Fractures After Bariatric Surgery and Its Relationship with Bone Mineral Density and Bone Markers.

Bariatric surgery (BS) can lead to bone loss and an increased fracture risk. To determine the morphometric vertebral fracture (MVF) prevalence, and its relationship with bone mineral density (BMD), and biomarker's turnover after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), we analyzed post-surgery X-rays of the spine in 80 patients (88% female, 51% RYGB, age 41.2 [6.8] years) from 117 participants' retrospective cohort (1-2 years, >2 and <5 years, and >5 years). We still analyzed body composition and BMD by dual-energy X-ray absorptiometry and bone parameters. MVF prevalence was 17.5% (14/80), with no statistical difference between groups (p = 0.210). RYGB group had a higher prevalence of secondary hyperparathyroidism (SHPT) (PTH ≥ 65 pg/ml; 18.4% vs 7.8%, respectively, p = 0.04), PTH (61.3 vs 49.5 pg/ml, p = 0.001), CTX (0.766 [0.29] ng/ml vs 0.453 [0.30] ng/ml, p = 0.037), and AP (101.3 [62.4] U/L vs 123.9 [60.9] U/L, p = 0.027) than the SG group. Up to 5 years postoperatively, RYGB had a lower total (1.200 [0.087] vs 1.236 [0.100] g/cm2, p = 0.02), femoral neck (1.034 [0.110] vs 1.267 [0.105], p = 0.005), and total femur BMD (1.256 [0.155] vs 1.323 [0.167], p = 0.002) than SG group. We found no statistically significant difference between the MFV (+) and MVF (-) groups regarding age, sex, BMI, surgery time, BMD, or bone and metabolic parameters, including leptin. We found a high prevalence of MVF after BS with no differences between RYGB and SG.

Bone loss and new vertebral fractures during treatment with romosozumab: a case-report

PurposeThis study aimed to illustrate the possibility of an unfavorable response to treatment with the anabolic agent romosozumab for patients with severe osteoporosis and to discuss explanations for treatment failure.MethodsDual-energy x-ray absorptiometry (DXA) including vertebral fracture assessment (VFA) and X-rays of the thoracolumbar spine was used to assess bone mineral density (BMD) and the presence of vertebral fractures before and after treatment with romosozumab.ResultsOur patient developed a decrease in the BMD of the hip, two incident new vertebral fractures, and worsening of one prevalent vertebral fracture during 1 year treatment with romosozumab. We have not detected non-adherence, there was no pretreatment with anti-resorptives, and we observed no signs of secondary osteoporosis and/or comorbidities.ConclusionAs the number of patients treated with romosozumab is rising, it becomes more likely that more patients will be found with new fractures and/or an unfavorable BMD response. Probably, the unfavorable response is a (bad) chance finding, but we think it is crucial for clinicians and patients to exclude nonadherence, new comorbidities and pretreatment with anti-resorptives as explanation in these patients.

Prevalence, incidence of and risk factors for vertebral fracture in the community: the Vietnam Osteoporosis Study

The epidemiology of vertebral fractures (VF) in underrepresented populations is not well-documented. This cohort study was part of a longitudinal osteoporosis research project with the aim of determining the prevalence, incidence, and risk factors for VF. 401 individuals (155 men) aged 50 years and older without a clinical diagnosis of VF were took radiographs at baseline and 2 years later. VF were ascertained using the Genant's semi-quantitative method. Bone mineral density (BMD) of femoral neck and lumbar spine were measured by dual-energy X-ray absorptiometry (Hologic Inc). The association between VF and risk factors was analyzed by the multiple logistic regression. The 95% confidence interval for prevalence and incidence was estimated by exact Poisson test. At baseline, the prevalence of VF was 12.2% (n = 49, 95% CI 9.0–16.2%) and increased with advancing age with one-fifth of those aged 70 and older having a VF. During the follow-up period, we observed 6 new VF, making the incidence of 6.6/1000 person-years (n = 6, 95% CI 2.4–14.3). The risk of prevalent VF was associated with male gender (OR: 2.67; 95% CI 1.28–5.87) and T-score at the femoral neck (OR per one SD decrease: 1.1; 1.03–1.17). These data indicate that VF is common among adults, and that lower femoral neck BMD was a risk factor for VF.

Proportion of Hidden Vertebral Fractures Among Egyptian Males With Fragility Hip Fractures in the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures are linked to significant costs for society as well as significant pain and suffering, disability, and even death. It is well-recognized that osteoporosis-related fragility fractures raise the risk of subsequent fragility fractures. One of the most frequent osteoporotic fractures brought on by low bone mineral density and other risk factors is vertebral fractures. Considering that most vertebral fractures are asymptomatic and not clinically identified, proactive screening could stop additional impairment. Objective The current study aims to determine the prevalence and risk factors of hidden vertebral fractures in Egyptian males who have fragility hip fractures. Patients and methods A cross-sectional case-control study examining the correlation of risk factors between cases (fragility hip fracture and vertebral fractures) and a control group (fragility hip fracture without vertebral fracture) was carried out from September 2020 to September 2021 on patients visiting the orthopedic emergency department of a university hospital in Cairo, Egypt. Males who presented to the emergency room (ER) with fragility hip fractures and were 40 years of age or older met our inclusion criteria. For every patient who presented with a fragility hip fracture, standard lateral and anteroposterior radiographs of the dorso-lumbar spine were taken. Results A total of 43,935 patients visited the orthopedic emergency room (ER) throughout the study period; 13,034 of those patients were men, accounting for 29.7% of all orthopedic ER visits. Our inclusion criteria for fragility hip fractures were met by 132 male participants. The screening lumbosacral plain X-rays identified 27 (20.5%) of the 132 patients as having concomitant vertebral fractures in addition to the fragility hip fractures. Concomitant hidden vertebral fractures among Egyptian males with other fragility fractures, particularly fragility hip fractures, are predicted by the number of co-morbid diseases, hypertension, and continuous use of steroids and anti-epileptics. Conclusion Most fragility fractures are avoidable. Because one fragility fracture increases the likelihood of others, early detection is crucial. To prevent complications and mortality, it is important to identify and manage individuals who have a fragility hip fracture as they frequently have concurrent hidden vertebral fractures. Predictive risk factors for fragility vertebral fractures include hypertension, the number of concomitant illnesses, and chronic drugs (anti-epileptics and steroids).

Prevalence of Osteoporosis and Osteoporotic Vertebral Fractures in Turkish Patients with Ankylosing Spondylitis: A Retrospective Cross-sectional Study

Prevalence of Osteoporosis and Osteoporotic Vertebral Fractures in Turkish Patients with Ankylosing Spondylitis: A Retrospective Cross-sectional Study

Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture

Background: Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures.Methods: We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA.Results: The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; &lt;i&gt;p&lt;/i&gt;&lt;0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; &lt;i&gt;p&lt;/i&gt;=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD.Conclusions: Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.

High prevalence of vertebral fractures associated with preoperative cortisol levels in patients with recent diagnosis of Cushing disease

Background/objective Morphometric vertebral fractures (VFs) and osteopathy are prevalent and clinically significant complications of Cushing disease (CD). However whether they represent an early occurrence in the natural progression of the disease is an ongoing debate. This study aimed to assess the prevalence and determinants of VFs in patients newly diagnosed with CD. Patients and methods This cross-sectional case–control study recruited 75 newly diagnosed CD patients and compared them with a control group of individuals without pituitary disorders or secondary forms of osteoporosis. Demographic, clinical and biochemical data were collected. The VFs were assessed using preoperative lateral chest radiography. Results We found a significantly higher prevalence of VFs in the CD group than in the control group (58.7% vs. 14.5%; P < 0.001). Among the CD patients with VFs, 27 (61.4%) showed moderate/severe VFs. The CD patients with VFs had significantly higher preoperative 8 am serum cortisol (8ASC) levels than those without VFs (P < 0.001). The preoperative 4 pm adrenocorticotropic hormone (ACTH) levels (P = 0.031), preoperative 0 am ACTH levels (P = 0.021) and systolic blood pressure were slightly higher in CD patients with VFs than in those without VFs (P = 0.028). A binary multiple logistic analysis showed that 8ASC was an independent predictor of VF risk (P = 0.003). The optimal cut-off value of the preoperative serum 8ASC level for predicting VFs was 22.18 ng/mL. Conclusions This is the first study reporting a high prevalence of radiologic VFs in recently diagnosed CD patients. VFs may represent an early manifestation of CD and may be related to cortisol levels. Therefore, VF assessment should be included in the workup during CD diagnosis.

Diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis—similarities and differences

Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axSpA) are diseases with inflammatory involvement of the axial skeleton that can result in new bone formation that may lead to total ankylosis of the spine and functional impairment of different extent in individual patients. In these diseases, the new bone formation may lead to total ankylosis of the spine and impaired mobility with functional impairment. This review will highlight the similarities and differences of these two conditions. In axSpA, the genetic background with the association with human leukocyte antigen-B27 (HLA-B27) is known for 50 years, while in DISH, a genetic contribution is not yet proven. The phenotype of new bone formation and its anatomic features are different between these diseases. In axSpA symmetric, thin and marginal syndesmophytes representing an ossification of enthesitic inflammation at the area of the attachment of the annulus fibrosus that may extend to the adjacent deeper layers anterior longitudinal ligament and are typical, while in DISH the so-called “chunky bridging osteophytes” grow as an additional layer on the anterior longitudinal ligament. Besides distinct anamnestic and clinical features, magnetic resonance imaging is helpful differentiating the two diseases since inflammatory changes with the typical pattern of axSpA are reliably visualized. Similar in both diseases is the high prevalence of vertebral fractures, which are mainly caused by the local osteoporosis and decreased flexibility of the affected bones, and therefore may occur even after minor traumata. The presence of extraarticular manifestations like uveitis, inflammatory bowel disease or psoriasis are only linked to axSpA. In contrast, DISH is associated with obesity, diabetes mellitus, and other metabolic diseases. Although DISH and axSpA are distinct conditions, the cooccurrence of these two diseases exists in some patients. Various therapeutic options are becoming available for axSpA, but no therapy has been approved for DISH yet.

Osteoporosis and Fragility Fractures in Patients With Cirrhosis Evaluated for Liver Transplantation: Identification of High-Risk Patients Based on Computed Tomography at Evaluation.

Osteoporosis in candidates for liver transplantation (LT) is often underdiagnosed despite the important consequences of morbidity. We included 376 patients with cirrhosis evaluated for LT with available computed tomography (CT) scans. Prevalent vertebral fractures (VFs) were identified on CT reconstructions, and bone density was assessed by measuring CT attenuation of the L1 vertebra (L1-CT). We identified 139 VFs in 55 patients (14.6%). Logistic regression models showed that low L1-CT was the only independent determinant of VF. In patients with cirrhosis evaluated for LT, CT scans identified persons with severe osteoporosis without additional costs.

FRI180 Prevalence Of Vertebral Fractures In Patients With Adrenal Adenomas

Abstract Disclosure: H. Han: None. H. Lam: None. S.D. Rao: None. S. Athimulam: None. Background: Approximately 5% of adults undergoing cross-sectional imaging are reported to have an adrenal adenoma. Although most adenomas are considered non-functioning (NFAT), up to 48% can present with mild autonomous cortisol secretion (MACS). Published studies have reported an increased prevalence of vertebral fractures (VFx) in MACS. However, findings are limited by sample size, selection bias and lack of diversity in patient population. Objective: To determine the prevalence of vertebral fractures and associated risk factors in patients with adrenal adenomas Design: Retrospective cross-sectional study of patients with adrenal adenomas over a 10-year period (Jan 2012 - Dec 2021). Setting: Academic primary and tertiary care setting Main outcomes measured: 1) MACS was diagnosed based on cortisol level ≥ 1.8cmg/dL after overnight 1mg dexamethasone suppression testing (DST) and NFAT if cortisol &amp;lt; 1.8mcg/dL. Patients who did not undergo 1mg DST were categorized as unknown cortisol status (UCS).2) Bone mineral density (BMD), T- and Z-scores of the lumbar spine (LS). 3)Vertebral morphometry, as assessed by Genant scale, to identify asymptomatic vertebral fractures. Results: Preliminary results included 198 patients with adrenal adenomas [(135 women (67%) with a median age of 67y, 106 Black (54%), 83 White (42%) and 9 other races (4%)]. 74 patients (37%) were diagnosed with NFAT, 42 (21%) with MACS, and 82 (41%) with UCS. Prevalence of vertebral fractures by vertebral morphometry assessment was 6%. (n=12, 5 Black, 7 White). In those with VFx (8 UCS, 2 MACS, 2 NFAT), Black patients had lower BMD (Mean BMD ± SD in Black vs Caucasians: 0.85 ± 018 vs 1.02 ± 0.24 g/cm2, p=0.26). Overall, there was no significant difference in mean LS BMD ± SD (0.97 ± 0.23 vs 1.03 ± 0.20 g/cm2, p=0.41) and mean T-score LS ± SD (-1.11 ± 2.28 vs -0.60 ± 1.71, p=0.49), in patients with and without vertebral fractures, respectively. Conclusions: Patients with adrenal adenoma are at risk of vertebral fractures despite normal or osteopenic BMD. Black patients with adrenal adenomas and vertebral fractures have lower BMD compared to White patients. 41% (n=82, 61% AA, 30% Caucasians, 2% Other) of patients were classified as unknown cortisol status indicating further need to educate health care professionals on evaluation of adrenal adenomas to improve health care outcomes and disparities in management. Presentation: Friday, June 16, 2023