Grade 1 Vertebral Fractures Identified by Densitometric Lateral Spine Imaging Predict Incident Major Osteoporotic Fracture Independently of Clinical Risk Factors and Bone Mineral Density in Older Women

Abstract

Because prevalent vertebral fracture (VF) is a strong predictor of future fractures, they are important to identify in clinical practice as osteoporosis medications are effective and can be used to reduce fracture risk in postmenopausal women with VF. Lateral spine imaging (LSI) with dual-energy X-ray absorptiometry (DXA) can be used to diagnose VFs accurately but is not widespread in clinical practice. The prognostic value of grade 1 (20% to 25% compression) VFs diagnosed by LSI with DXA has been insufficiently studied. The aim of this study was to determine if grade 1 VF is associated with incident fracture in older women. Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) is a population-based study of 3028 older women from Gothenburg, Sweden. Included women were 75 to 80 years of age at baseline, answered questionnaires, and were scanned with DXA (Discovery A, Hologic, Waltham, MA, USA). LSI was used to diagnose VFs, which were classified using the Genant semiquantitative method. Cox regression models were used to estimate the association between VFs at baseline and X-ray-verified incident fractures, with adjustment for confounders. Women with a grade 1 VF (n = 264) or a grade 2-3 VF (n = 349) were compared with women without any fracture (n = 1482). During 3.6 years (median, interquartile range [IQR] 1.5 years) of follow-up, 260 women had any incident fracture and 213 a major osteoporotic fracture (MOF). Women with only grade 1 VF had increased risk of any fracture (hazard ratio [HR] = 1.67; 95% confidence interval [CI] 1.18-2.36) and MOF (HR = 1.86; 95% CI 1.28-2.72). For MOF, this association remained after adjustment for clinical risk factors and femoral neck bone mineral density (BMD). In conclusion, grade 1 VFs were associated with incident MOF, also after adjustment for clinical risk factors and BMD, indicating that all VF identified by DXA should be considered in the evaluation of fracture risk in older women.

Grade 1 vertebral fractures, bone mineral density, and the risk of fractures

“…Finally, the incidence of VF (6.6%) and the incidence rate (15.55 women/10 3 per year) that our group reported in 2019 were very similar to those depicted by Johansson et al (1) in their present study.…”

“…We read with great interest the recent article by Johansson et al (1) about grade 1 vertebral fractures (VFs) identified by vertebral fracture assessment (VFA) and the prediction of incident fractures in older women. We discuss several aspects of their article.…”

“…Indeed, other researchers have published different VFA-based approaches to describe the relationship between prevalent and incident VF. (3)(4)(5) Second, Johansson et al (1) evaluated whether the association between prevalent grade 1 VF and the incidence of new fractures was independent of clinical risk factors and bone mineral density (BMD). The authors classified new fractures into three groups: any incident fracture, incident major osteoporotic fractures (MOFs), and incident VF.…”

Improving osteoporotic vertebral deformity detection on chest frontal view radiograph by adjusted X-ray beam positioning

“…Johansson et al. [ 35 ] reported that grade 1 OVFs were associated with incident major osteoporotic fracture after adjustment for clinical risk factors and bone mineral density. In one recent study of ours [ 30 ], of the total five women with baseline minimal OVF, three had osteopenia and two had osteoporosis, and their OVF progression or new incident OVF rate at year-14 follow-up was similar to the women with baseline apparent OVF.…”

Update on bone health: the International Menopause Society White Paper 2021

“…In the case of asymptomatic morphometric fractures of the spine, the grade of the fracture (mild, moderate or severe) most likely also correlates with risk of subsequent fracture [8]. This can be determined by vertebral fracture assessment (VFA), a function of most modern dual-energy X-ray absorptiometry (DXA) devices, or by conventional X-rays.…”