Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS)

Abstract

The aim of this analysis was to determine the influence of lifestyle, anthropometric and reproductive factors on the subsequent risk of incident vertebral fracture in men and women aged 50-79 years. Subjects were recruited from population registers from 28 centers across Europe. At baseline, they completed an interviewer-administered questionnaire and had lateral thoraco-lumbar spine radiographs performed. Repeat spinal radiographs were performed a mean of 3.8 years later. Incident vertebral fractures were defined morphometrically and also qualitatively by an experienced radiologist. Poisson regression was used to determine the influence of the baseline risk factor variables on the occurrence of incident vertebral fracture. A total of 3173 men (mean age 63.1 years) and 3402 women (mean age 62.2 years) contributed data to the analysis. In total there were 193 incident morphometric and 224 qualitative fractures. In women, an age at menarche 16 years or older was associated with an increased risk of vertebral fracture (RR = 1.80; 95%CI 1.24, 2.63), whilst use of hormonal replacement was protective (RR = 0.58; 95%CI 0.34, 0.99). None of the lifestyle factors studied including smoking, alcohol intake, physical activity or milk consumption showed any consistent associations with incident vertebral fracture. In men and women, increasing body weight and body mass index were associated with a reduced risk of vertebral fracture though, apart from body mass index in men, the confidence intervals embraced unity. For most variables the strengths of the associations observed were similar using the qualitative and morphometric approaches to fracture definition. In conclusion our data suggest that modification of other lifestyle risk factors is unlikely to have a major impact on the population occurrence of vertebral fractures. The important biological mechanisms underlying vertebral fracture risk need to be explored using new investigational strategies.

Alcohol and older people from a public health perspective

“…Similarly, there are mixed findings between alcohol intake and the risk of fractures, with some studies finding no relationship [37], and others finding that light drinking protects against the risk of fractures, whilst problems drinking increases the risk of fractures [38].…”

Catch up in bone acquisition in young adult men with late normal puberty

“…Late menarche has been associated with low BMD and higher fracture risk at several sites in postmenopausal women, (1)(2)(3)(4)(5) and in premenopausal women early menarche has been associated with high BMD. (24,25) In the present study, no significant differences in aBMD or BMC of the lumbar spine, femoral neck, or total body between men with early, middle, or late puberty at 24 years of age were ascertained.…”

“…In postmenopausal women, late menarche has been associated with lower BMD as well as an increased risk of fractures of the forearm, vertebrae, and hip. (1)(2)(3)(4)(5) More recent studies have shown an association between late menarche and lower BMD in young adulthood and in premenopausal women. (6,7) The influence of pubertal timing on adult BMD in men is not clear.…”

Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis

“…An estimated 1,700,000 vertebral compression fractures (VCFs) occur every year in the US and in Europe, a figure that is likely to rise over the coming decades [5,14,15]. The burden of VCFs can be substantial, in particular chronic pain, a marked reduction in health-related quality of life and high healthcare costs [1,5].…”