Mortality Associated with Vertebral Deformity in Men and Women: Results from the European Prospective Osteoporosis Study (EPOS)

Abstract

Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire--the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available from 6480 subjects, aged 50-79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and 133 men) occurred during a total of 14,380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95% confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use, the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8). Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess can be explained by an association with other adverse health and lifestyle factors linked to mortality.

A Comparison of Survival Rates for Hip Fracture Patients with or without Subsequent Osteoporotic Vertebral Compression Fractures

“…However, patients in the single hip fracture group showed a higher HR for mortality than patients with a subsequent fracture. This finding is contrary to previous studies showing that vertebral fractures correlate with an elevated risk of mortality in elderly people (Cooper et al 1993;Ismail et al 1998;Kado et al 1999;Ensrud et al 2000). This discrepancy may be explained by the different study population; a different cohort may have underlying diseases or other physical conditions endemic to a certain geographical location.…”

Height loss starting in middle age predicts increased mortality in the elderly

“…Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality. (9) Other studies, however, showed no evidence of increased mortality among elderly with vertebral fracture. (10) Increased mortality after hip fracture was observed in several studies.…”

Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study

“…However, trials that have examined the relation between fractures and mortality have had limitations that may influence their results and the generalizability of the studies, including small samples, 3,4 the examination of only 1 type of fracture, [4][5][6][7][8][9][10] the inclusion of only wo men, 8,11 the enrolment of participants from specific areas (i.e., hospitals or certain geographic regions), 3,4,7,8,10,12 the nonrandom selection of participants [3][4][5][6][7][8][9][10][11] and the lack of statistical adjustment for confounding factors that may influence mortality. 3,[5][6][7]12 We evaluated the relation between incident fractures and mortality over a 5-year period in a cohort of men and women 50 years of age and older. In addition, we examined whether other characteristics of participants were risk factors for death.…”