Prevalent Vertebral Fractures Research Articles

12478 A Pilot Evaluation Of Automated Morphometry Performance On Vertebral Fracture Assessment (vfa) And Its Impact On Interpretation

Abstract Disclosure: S. Syed: None. N. Binkley: None. Introduction: Prevalent vertebral fractures convey increased fracture risk but are often clinically silent; thus, imaging is required for their detection. Vertebral fracture assessment (VFA) can be performed at the time of DXA. We hypothesized that VFA automated morphometry does not accurately identify the number of vertebrae visualized nor the number of fractures present and sought to begin exploring if morphometry impacted the formal interpretation. Methods: Patients seen by an Orthopedic bone health provider were studied. Their VFA images were independently assessed by two physicians, after which a consensus “gold standard” (GS) reading was reached. The number of vertebral bodies able to be assessed and the number of fractures identified by morphometry (M), the formal interpretation (I) and the GS result were compared by one way ANOVA. Results: The study cohort included 100 patients with mean (SD) age 77.6 (8.6) years, 81% female with BMI 26.7 (5.0) kg/m2, 91 of whom had prior clinical fracture. M reported visualizing more vertebral bodies than I and GS; 1243, 1168 and 1063 respectively. I identified numerically more (13) fractures than did M (150 vs. 137) but was lower than GS (167). The automated and formal reports were identical in 52 patients; in this subgroup, 8 patients (15%) had vertebral fractures that were not identified on the formal interpretation. In this same group of 52 patients, an additional 7 (13%) with vertebral fractures had 9 vertebral fractures missed. Conclusion: In this pilot study assessing VFA, automated vertebral morphometry reports identifying more vertebrae than are actually able to be evaluated while missing almost 18% of vertebral fractures that were actually present. That the formal interpretation is identical to that of morphometry in over 50% of patients, while missing vertebral fractures over 12% of the time, implies that morphometry is adversely impacting the formal interpretation and thereby potentially patient care. Further study with larger datasets is indicated. Presentation: 6/3/2024

Influence of Screw Length and Cement Position Within the Injured Vertebra on Fixation Strength in Short-Segment Fixation of Osteoporotic Thoracolumbar Burst Fractures

The prevalence of osteoporotic vertebral fractures has increased with aging populations, necessitating effective treatments such as percutaneous kyphoplasty combined with posterior screw fixation. However, biomechanical research on the effects of using short screws on fixation stability and bone stress or on the impact of bone cement bonding to screws on structural strength is lacking. This study aimed to optimize short-segment fixation strategies for osteoporotic thoracolumbar burst fractures by analyzing the biomechanical effects of pedicle screw length and bone-cement augmentation. Four models of the thoracolumbar spine were established using computed tomography data of a female volunteer: (1) short screws in the injured vertebra without contact with the bone cement, (2) long screws without contact with the bone cement, (3) long screws in contact with the bone cement; and (4) long screws without the bone cement. The four fixation models were simulated under physiological loads. The range of motion, implant stress, and segmental stability were assessed. The three groups containing the bone cement exhibited similar performances in terms of stability and stress distribution, whereas the group without the bone cement exhibited a poorer biomechanical performance. Incorporation of the bone cement enhanced the biomechanical properties of the structure, and short screws in the injured vertebra without contact with the bone cement did not significantly compromise the biomechanical performance. Short screws in injured vertebrae without contact with the bone cement can achieve satisfactory stability and stress distribution. It is feasible to implant short screws in the injured vertebrae, reduce the number of bilaterally injured vertebrae, and inject bone cement through the non-pedicle approach during the surgical procedure, which simplifies the surgical process.

Opportunistic Screening for Low Bone Mineral Density in Routine Computed Tomography Scans: A Brazilian Validation Study

Introduction/background: Osteoporotic fractures are a major health concern worldwide due to high mortality rates, deterioration in quality of life, and elevated healthcare costs related to hospital treatment. However, most patients who sustain an osteoporotic fracture have never been formally screened for osteoporosis. Opportunistic screening of osteoporosis through conventional computed tomography (CT) scans performed for unrelated reasons could help identify patients with low bone mass. There are currently no studies validating the opportunistic screening of low bone mass through CT in South America. The aim of our study is to assess whether conventional CT scans could be used for the opportunistic screening of osteopenia and osteoporosis in Brazilian patients.Methodology: Patients who underwent unenhanced CT and dual-energy X-ray absorptiometry (DXA) scans within a six-month interval were assessed retrospectively. Mean CT attenuation was measured in the first lumbar vertebra (L1) in axial, coronal, and sagittal planes and compared to their respective DXA T-scores; vertebral fractures were assessed in the sagittal plane. Potential thresholds suggestive of low bone mass density (BMD) were established using receiver operating characteristics analysis.Results: 491 patients were included (93.2 % female; mean age of 64.1 ± 9.8 years; mean interval of 63.5 days between scans). Mean L1 CT attenuation was significantly lower in osteopenic and osteoporotic patients in all CT planes (p < 0.001). Positive linear correlations were found between DXA T-scores and the average L1 attenuations in all CT planes (p < 0.001). An average L1 attenuation equal or below 100 Hounsfield Units (HU) in the sagittal plane identified low BMD (osteopenia or osteoporosis) with a specificity of 96.3 % and a positive predictive value of 96 %. In contrast, an average L1 attenuation above 180 HU demonstrated a sensitivity of 97.6 % and a negative predictive value of 94.9 % for detecting osteoporosis. Patients with L1 sagittal attenuation at or below 100 HU exhibited a significantly higher prevalence of vertebral fractures (prevalence ratio: 8.67; p < 0.001). An online calculator based on the results of this study is freely available at www.osteotc.com.br.Conclusions: Routine CT scans can identify probable low bone density (osteopenia or osteoporosis) in Brazilian patients without additional costs or radiation exposure. Opportunistic CT screening does not substitute formal bone mineral density assessment; instead, it assists in identifying patients who may benefit from it.

High disease activity influences the presence of vertebral fractures in rheumatoid arthritis.

It is important to assess the risk of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA), as RA is associated with a high risk of VFs. However, the epidemiology and risk of VFs in patients with RA remain inconclusive. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA. We included 107 patients (19 men and 88 women) and retrospectively investigated the number and location of VFs, bone mineral density (BMD), RA disease activity score for 28 joints based on C-reactive protein (DAS28-CRP), and history of medication for RA and osteoporosis. Based on the investigated items, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. The average age, disease duration, and DAS28-CRP were 67.9 years old, 14.9 years, and 2.2, respectively. We found that the prevalence of VFs in patients with RA was 30.8%, and 84.8% of patients with VFs and 62.2% of those without VFs had been treated for osteoporosis. We further found that the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use was 37.8%. In univariate analyses, patients with RA with VFs had significantly higher DAS28-CRP values, a higher rate of corticosteroid use, and lower BMD (p = 0.018, p = 0.004, and p < 0.001, respectively) than those without VFs. A multivariable logistic regression analysis and ordinal logistic analysis revealed that the DAS28-CRP and BMD were independent factors associated with the presence (p = 0.042 and p = 0.011, respectively) and number (p = 0.036 and p = 0.048, respectively) of VFs. The prevalence of VFs was relatively high in patients with RA, regardless of the use of anti-osteoporotic agents. A high disease activity score and low BMD are associated with the presence and number of VFs in patients with RA. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA in addition to osteoporosis treatment.

Association between renal function and fracture incidence during treatment with teriparatide or alendronate: an exploratory subgroup analysis of the Japanese Osteoporosis Intervention Trial-05.

Incidence rate of morphometric vertebral fracture was lower under treatment with once-weekly teriparatide (TPTD) followed by alendronate (ALN) than under treatment with ALN throughout the study among elderly Japanese women at high fracture risk in JOINT-05. This is an exploratory subgroup analysis according to chronic kidney disease (CKD) status at baseline. Participants received sequential therapy with TPTD for 72weeks, followed by ALN for 48weeks (TPTD-ALN group, N = 483) or ALN monotherapy for 120weeks (ALN group, N = 496). Baseline CKD status was classified by the estimated glomerular filtration rate (eGFR) and categorized as: CKD 1/2 (eGFR ≥ 60mL/min/1.73 m2), CKD 3a (eGFR 45-59mL/min/1.73 m2), or CKD 3b/4 (eGFR < 45mL/min/1.73 m2). Incidences of vertebral fractures including morphometric fractures, non-vertebral fractures, and all fractures were evaluated during follow-up. Baseline characteristics were not different between treatment groups. Higher stages of CKD were associated with age and number of prevalent vertebral fracture. In CKD 1/2 patients (N = 556 with 90 incidents of morphometric vertebral fracture), the incidence of vertebral fractures was lower in the TPTD-ALN group than in the ALN group (p = 0.01). In CKD 3b/4 patients (N = 112 with 10 incidents of non-vertebral fracture), the incidence of non-vertebral fractures was lower in the ALN group than in the TPTD-ALN group, although the number of fractures was small. In the ALN group, the incidences of vertebral fractures, non-vertebral fractures, and all fractures remained constant across CKD stages. This exploratory analysis showed that fracture incidence on ALN was constant regardless of renal function. It also suggested that the incidence of vertebral fractures on TPTD-ALN was lower than ALN monotherapy in CKD 1/2 patients. These results provide important information for drug selection in the clinical practice of osteoporosis.

Prevalence of vertebral fractures and associated factors in thai diabetic postmenopausal women

T2DM (Type 2 Diabetes Mellitus) patients with vertebral fractures have a higher mortality rate than non-DM (nondiabetic patients). However, the prevalence of vertebral fractures in the Asian diabetic population is not well established. Moreover, despite an apparent increase in fracture risk in patients with diabetes, Asian countries have provided contradictory data demonstrating that bone mineral density (BMD) varies significantly in T2DM patients. The aim of this study was to examine and compare the prevalence of vertebral fractures and osteoporosis, as well as BMD and the FRAX score, between individuals with and without T2DM and assess the association of these factors with vertebral fractures. Postmenopausal Thai women attending diabetic and health check-up clinics were recruited. BMD at the lumbar spine, total hip, and femoral neck was measured via dual-energy X-ray absorptiometry. A morphometric vertebral fracture (VF) was defined by a lateral thoracolumbar (T-L) X-ray radiograph. The Fracture Risk Assessment Tool (FRAX) was used to calculate the 10-year probabilities of hip and major osteoporotic fracture (MOF), which were calculated on the basis of the Thai FRAX model. A total of 435 participants were recruited, including 145 postmenopausal women with T2DM and 290 non-DM individuals. T2DM patients had a significantly greater BMI (p = 0.006) and BMD at the femoral neck (p = 0.024) and total hip (p = 0.017), but there was no significant difference in the FRAX score, including the 10-year probability of hip fracture or MOF, either with or without BMD, between individuals with and without T2DM. The prevalence of osteoporosis in non-DM women was significantly higher at the femoral neck (OR = 0.56, 95% CI: 0.34 to 0.93, p = 0.029) but comparable at the lumbar spine. Individuals with T2DM had a significantly higher rate of vertebral fractures, particularly those involving two or more levels, than those without T2DM. Diabetes was significantly associated with \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document}2 VF (OR = 3.83, 95% CI: 1.77 to 8.28, p = 0.001), and the association remained unchanged after controlling for other clinical factors (adjusted OR = 3.72, 95% CI 1.70–8.15; p = 0.001). Our study demonstrated a greater prevalence of multiple (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document} two levels) VFs in women with T2DM than in non-DM controls.

Association between trabecular bone score, 10-year probability risk for fracture, and vertebral fractures in rheumatoid arthritis

ObjectivesThe aim was to assess the association and predictive value of trabecular bone score (TBS), fracture risk assessment tool (FRAX), and TBS-adjusted FRAX with prevalent vertebral fractures (VFs) in patients with rheumatoid arthritis (RA). MethodsPatients diagnosed with RA were included in this cross-sectional study. Clinical data and laboratory tests were collected on the same day as the dual-energy x-ray absorptiometry (DXA) scan. TBS, bone mineral density (BMD), and vertebral fracture assessment (VFA) were obtained from the DXA scan. We used the FRAX tool to assess the 10-year probability of major osteoporotic fracture (MOF-FRAX) and hip fracture (HF-FRAX) with and without BMD. These parameters were further adjusted for TBS. Patients with prevalent VFs were defined as those with moderate to severe VFs from T4 to L4. VFs presence was used as the binary variable in the logistic regressions and receiving operator characteristics (ROC) curves analysis. ResultsSixty-nine patients were enrolled, with 55.1 % being postmenopausal. The mean TBS was 1.328 ± 0.104. Osteoporosis according to the WHO criteria was present in 39 patients (56.5 %), and six patients (8.7 %) had VFs with thoracic predominance (66.67 %). Univariate and multivariate logistic regression analyses did not show an association between TBS and vertebral fractures, but FRAX scores indicated such an association. The area under the curve (AUC) with 95 % confidence intervals (CI) for the MOF-FRAX score with BMD, MOF-FRAX score without BMD, TBS-adjusted MOF-FRAX score, and TBS were 0.837 [0.686–0.988], 0.795 [0.629–0.961], 0.778 [0.571–0.984], and 0.515 [0.298–0.731], respectively. ConclusionIn our RA patients, FRAX scores were associated with vertebral fractures (VFs), while TBS was not. The MOF-FRAX score combined with BMD, showed the best AUC for VFs in this population.

Review of Incidence and Risk Factors for Spinal Fauctures in Canines

A survey was conducted to analyze vertebral fractures in dogs presented to the Madras Veterinary College Orthopaedic Outpatient Unit during a period of one and half year. A total of 24 cases were included, predominantly males with an average weight of 16 to 18 kilograms. The primary causes identified were road traffic accidents (n=15) and high-rise syndrome (n=9), affecting predominantly dogs aged 5 months to 2 years (n=14). Non-descript breeds were most commonly affected. Fractures were most frequently observed in the caudal thoracic vertebrae (T11 to L1). CT myelography revealed ventral displacement in cases of luxation, primarily affecting the thoracolumbar and lumbosacral regions. This study underscores the prevalence and characteristics of vertebral fractures in dogs, highlighting the need for prompt diagnosis and appropriate management strategies.

Influence of serum uric acid on bone and fracture risk in postmenopausal women

AimsUric acid has been associated with several metabolic conditions, including bone diseases. Our objective here was to consider the relationship between serum uric acid levels and various bone parameters (bone mineral density, ultrasonographic parameters, vitamin D, PTH and serum calcium), as well as the prevalence and risk of fragility fracture.MethodsAn observational and cross-sectional study carried out on 679 postmenopausal women, classified into 3 groups according to their serum uric acid levels, in whom bone densitometry, calcaneus ultrasounds, PTH, vitamin D and serum calcium analysis were done. Bone fractures were collected through the clinical history and lateral spinal X-ray.ResultsHigher uric acid levels were found in women with older age, high BMI, diabetes, and high blood pressure. Higher levels of PTH and serum calcium were also observed, but did not effect on vitamin D. Serum uric acid was positively related to densitometric and ultrasonic parameters and negatively associated with vertebral fractures.ConclusionsIn the population of postmenopausal women studied, sUA levels were correlated with BMD, BUA, and QUI-Stiffness, and this correlation was independent of age and BMI. In addition, sUA was associated with a decrease in vertebral fractures. These results imply a beneficial influence of sUA on bone metabolism, with both a quantitative and qualitative positive effect, reflected in the lower prevalence of vertebral fractures.

The Role of the GH Receptor Polymorphisms as a Prognostic Factor of Vertebral Fractures in Acromegalic Patients Resistant to First-generation SSAs and Treated with Pegvisomant or Pasireotide LAR.

Acromegaly is associated with skeletal fragility and increased prevalence of vertebral fractures (VF). Two isoforms of GH receptor (GHR) have been described, which differ in the presence or absence of a transcript of exon 3 of the GHR gene. Both isoforms produce a functional receptor, but the exon 3-deleted isoforms (d3-GHR) have greater sensitivity to endogenous and recombinant GH than the full-length isoform (fl-GHR). We conducted a longitudinal, retrospective, observational, single-center study to investigate the role of GHR polymorphism as a prognostic factor of incidental VF (I-VF) in firstgeneration somatostatin analogs (fg-SSAs)-resistant acromegalic patients and treated with Pegvisomant or Pasireotide LAR. Seventy-two patients with active acromegaly were included: 28 patients carried the d3-GHR isoform, and 44 patients carried the fl-GHR isoform. Forty-six patients were treated with Pegvisomant in combination with fg-SSAs, and 26 were treated with Pasireotide LAR. At the last follow-up, 58 patients achieved biochemical control of acromegaly. Eighteen patients carried prevalent VF (P-VFs), while 14 patients experienced the occurrence of I-VFs. From the group treated with Pegvisomant in combination with fg-SSAs, 32 patients carried the fl-GHR isoform, and 14 carried the d3-GHR isoform. From the group treated with Pasireotide LAR, 12 patients had the fl-GHR isoform, and 14 patients carried the d3-GHR isoform. I-VF occurred more frequently in patients with the fl-GHR isoform compared to d3-GHR (p =0.04); otherwise, I-VF occurred more frequently in patients with the d3-GHR isoform than fl-GHR (p =0.01). The GHR polymorphisms could improve the therapeutic approach in acromegaly, tailored to the individual patient, in the context of personalized medicine.

Prevalent morphometric vertebral fractures as a risk factor for subsequent clinical vertebral fractures after shortfusion surgery in older Japanese women with degenerative spondylolisthesis.

A retrospective cohort study using the Kaplan-Meier method with propensity-score matching. To evaluate whether the presence of prevalent morphometric vertebral fractures (VFs) poses a risk for subsequent clinical VFs after short-fusion surgery in women aged ≥60 years with degenerative spondylolisthesis. VFs are common osteoporotic fractures and are associated with a low quality of life. Subsequent VFs are a complication of instrumented fusion in patients with degenerative lumbar disorders. Thus, risk factors for subsequent VFs after fusion surgery must be analyzed. Population-based studies have suggested that prevalent morphometric VFs led to a higher incidence of subsequent VFs in postmenopausal women; however, no studies have investigated whether prevalent morphometric VFs are a risk factor for subsequent VFs after fusion surgery in patients with degenerative spondylolisthesis. The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [-] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (-) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis. Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (-) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching. The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.

Undiagnosed vertebral fragility fractures in patients with distal radius fragility fractures: an opportunity for prevention of morbimortality in osteoporotic patients in developing countries.

This study's main goal was to look into the frequency, location, kind, and severity of asymptomatic vertebral fragility fractures (VFF) in people who had fractures of the fragility of the distal radius. Although VFF is frequently misdiagnosed, it is linked to higher mortality, morbidity, and hip fracture risk. The study also attempted to investigate the relationship between VFF and certain demographic and lifestyle factors, as well as FRAX data, in this patient population. Between January, 2021, and January, 2022, individuals with low-energy distal radial fractures who presented to the emergency room of tertiary care hospital of Karachi, Pakistan, were the subject of a cross-sectional study and were 45years of age or older except those who fitted the exclusion criteria (n = 208). The thoracic and/or lumbar spine was imaged using radiology, and information on demographics, way of life, and FRAX (Fracture Risk Assessment Tool) was gathered. Using the Genant semiquantitative approach, an impartial and blinded orthopaedist identified VF in the images and determined their severity. SPSS version 20 was used to analyse the data. Two hundred eleven (41.21%) of them were found to have radiographic VFF and only 12 (2.34%) of the 512 patients who were tested were getting osteoporotic therapy. The thoracic spine (32.7%), followed by the lumbar spine (43.12%), was the area most frequently afflicted. In 24.17% of the patients, multiple fractures of the thoracolumbar spine were found. The wedge form (54.5%), followed by biconcave (30.81%) and crush (14.7%), was the most prevalent VFF type. The majority of detected VFF were rated as having a 25-40% height loss (64.9%) then severe (> 40%) fractures (35.1%), according to the Genant grading method. Notably, there were no variations in smoking, drinking, BMI, or FRAX score between patients with and without VFF that were statistically significant. Based on our study's findings, it is clear that osteoporotic vertebral fragility fractures occur in almost half of individuals with distal radius fractures. The lumbar spine is notably the most affected region, predominantly with wedge fractures. Given the high prevalence of asymptomatic vertebral fragility fractures (VFF), proactive measures are necessary to mitigate associated risks. Prioritising comprehensive fall risk assessments for these patients and interventions to enhance bone mineral density and strength are crucial. Early identification of asymptomatic VFF enables timely intervention, optimising patient care and minimising the risk of complications in this vulnerable population.

High prevalence of morphometric vertebral fractures opportunistically detected on thoracic radiograms in patients with non-functioning pituitary adenoma.

Vertebral fractures (VFs), the hallmark of skeletal fragility, have been reported as an emerging complication in patients with pituitary diseases associated with hormonal excess and/or deficiency, independently from bone mineral density. Non-functioning pituitary adenoma (NFPA) is amongst the most frequent pituitary adenomas; however, skeletal health in this context has never been investigated. We aimed at assessing the prevalence and the determinants of morphometric VFs in patients with NFPA. We enrolled 156 patients (79M/77F, mean age 55.75 ± 12.94years) at admission in Neurosurgery Unit before trans-sphenoidal surgery and compared them with an age and sex-matched control group of subjects with neither history/risk factors for secondary osteoporosis nor pituitary disorders. We performed a vertebral morphometric evaluation of the thoracic spine on pre-operative X-ray images (MTRx) and collected biochemical, demographic, and clinical data from the entire cohort. The prevalence of thoracic VFs in patients with NFPA was significantly higher than the control group (26.3% vs. 10.3%; p < 0.001). In the NFPA group, 20 patients (48.8% of the fractured patients) showed multiple VFs, 14 (34.1% of them) showed moderate/severe VFs. Patients with VFs were significantly older and had lower serum free triiodothyronine (fT3) levels than non-fractured ones (p = 0.002 and p = 0.004; respectively). The prevalence of secondary male hypogonadism was higher among men with VFs as compared to those with no VFs (72% vs. 48.1%; p = 0.047). Consistently, total testosterone levels in males were significantly lower in fractured patients than in non-fractured ones (p = 0.02). The prevalence of gonadotroph adenomas was significantly higher among patients with VFs (p = 0.02). In multiple logistic regression analysis, older age and lower serum fT3 levels were independent factors predicting the risk for VFs. For the first time, we reported a high prevalence of thoracic radiological VFs in patients with NFPAs. Our data should prompt clinicians to proceed with a clinical bone fragility evaluation already during the diagnostic work-up, particularly in those with concomitant hypogonadism, or in those with older age and/or with lower fT3.

High prevalence of vertebral fractures associated with age, GH, and bone mineral density in patients with acromegaly

High prevalence of vertebral fractures associated with age, GH, and bone mineral density in patients with acromegaly

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% CI) were 1.85 (1.59, 2.15) for those with compared with those without auto-PVFx, and 1.36 (1.14, 1.62) for those with high compared with low auto-AAC. The multivariable-adjusted HRs for incident hip fracture were 1.62 (95% CI, 1.26 to 2.07) for those with compared to those without auto-PVFx, and 1.55 (95% CI, 1.15 to 2.09) for those high auto-AAC compared with 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.