Subsequent Adverse Health Outcomes Research Articles

Gamma Holding NV, The Netherlands

Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity as hip fractures. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one quarter to one-third of vertebral fractures are recognized clinically at the time of their occurrence and otherwise require lateral spine imaging to be recognized. This article first reviews the prevalence and incidence of clinical and radiographic vertebral fractures in populations across the globe and secular trends in the incidence of vertebral fracture over time. Next, associations of vertebral fractures with measures of bone mineral density and bone microarchitecture are reviewed followed by associations of vertebral fracture with various textural measures of trabecular bone, including trabecular bone score. Finally, the article reviews clinical risk factors for vertebral fracture and the association of vertebral fractures with morbidity, mortality, and other subsequent adverse health outcomes.

Radiation-Related Health Risks

This issue ofTHE JOURNALincludes articles on the therapeutic uses of ionizing radiation and the long-term adverse health consequences of radiation exposure. The balancing of benefit and risk is critical both in assessing the utility of medical applications of radiation and nonmedical applications, such as nuclear power generation, where the Chernobyl incident demonstrated the potentially disastrous consequences of unsafe operation. 1 In many medical applications, such as radiotherapy for treating selected patients with cervical cancer as reported herein by Rotman et al, 2 direct benefits may often outweigh any long-term risk. However, some medical uses, such as mammographic screening, require a careful and quantitative analysis of the benefits and risks involved. Thus, a critical need exists to determine as precisely as possible the risks of subsequent adverse health outcomes following exposure to ionizing radiation. See also pp 387, 402, and 425. To date, the majority of data on such