Osteoporotic Vertebral Fractures are Common in Hip Fracture Patients and are Under-recognized

Kelly, Michael A.; McCabe, Eva; Bergin, Diane; Kearns, Stephen; McCabe, John P.; Armstrong, Catherine; Heaney, Fiona; Carey, John J.

doi:10.1016/j.jocd.2020.05.007

Cited by 16 publications

(19 citation statements)

References 33 publications

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“…The prevalence of VF at baseline ranges from 10 to 36% in those with normal BMD [26,28,43] and 13% to 37% in those with low BMD [25,28]. Patients with a prior fracture are at much greater risk of fracture [29][30][31], and although osteoporosis treatment is effective, fractures can still occur [25][26][27][28]43]. In our study, patients with VF were more likely to have a prior fracture (85% vs. 56%), have osteoporosis by DXA criteria (43% vs. 28%), and be taking osteoporosis treatment (52% vs. 31%).…”

Section: Discussionmentioning

confidence: 99%

“…Reasons include under-representation, under-diagnosis and limited data from non-hospital settings [29,[32][33][34]. Reports suggest hospital length of stay is similar to hip fractures [33], while others show VF are common when imaging studies are systematically evaluated [29,34]. Our experience suggests the prevalence and importance of VF are underappreciated by patients, medical staff, healthcare managers and government.…”

Section: Introductionmentioning

confidence: 87%

“…Their illness burden for patients and healthcare systems is also similar, but greater than forearm fractures [2-10, 18, 19]. Specific populations are at increased risk including those with rheumatic diseases [20][21][22][23], taking glucocorticoid therapy [24][25][26][27][28] or with previous fractures [13,[29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recent publications on the prevalence, incidence and impact of VF in Ireland highlight a paucity of studies [29,32]. Reasons include under-representation, under-diagnosis and limited data from non-hospital settings [29,[32][33][34]. Reports suggest hospital length of stay is similar to hip fractures [33], while others show VF are common when imaging studies are systematically evaluated [29,34].…”

Section: Introductionmentioning

confidence: 99%

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Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project

et al. 2021

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Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was − 1.4 and mean total hip T-scores was − 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40–49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project

et al. 2021

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Prevalence of Low Bone Mass and Osteoporosis in Ireland: the Dual‐Energy X‐Ray Absorptiometry (DXA) Health Informatics Prediction (HIP) Project

Carey

Erjiang²,

Wang

et al. 2023

JBMR Plus

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Osteoporosis is a common disease that has a significant impact on patients, healthcare systems, and society. World Health Organization (WHO) diagnostic criteria for postmenopausal women were established in 1994 to diagnose low bone mass (osteopenia) and osteoporosis using dual‐energy X‐ray absorptiometry (DXA)‐measured bone mineral density (BMD) to help understand the epidemiology of osteoporosis, and identify those at risk for fracture. These criteria may also apply to men ≥50 years, perimenopausal women, and people of different ethnicity. The DXA Health Informatics Prediction (HIP) project is an established convenience cohort of more than 36,000 patients who had a DXA scan to explore the epidemiology of osteoporosis and its management in the Republic of Ireland where the prevalence of osteoporosis remains unknown. In this article we compare the prevalence of a DXA classification low bone mass (T‐score < −1.0) and of osteoporosis (T‐score ≤ −2.5) among adults aged ≥40 years without major risk factors or fractures, with one or more major risk factors, and with one or more major osteoporotic fractures. A total of 33,344 subjects met our study inclusion criteria, including 28,933 (86.8%) women; 9362 had no fractures or major risk factors, 14,932 had one or more major clinical risk factors, and 9050 had one or more major osteoporotic fractures. The prevalence of low bone mass and osteoporosis increased significantly with age overall. The prevalence of low bone mass and osteoporosis was significantly greater among men and women with major osteoporotic fractures than healthy controls or those with clinical risk factors. Applying our results to the national population census figure of 5,123,536 in 2022 we estimate between 1,039,348 and 1,240,807 men and women aged ≥50 years have low bone mass, whereas between 308,474 and 498,104 have osteoporosis. These data are important for the diagnosis of osteoporosis in clinical practice, and national policy to reduce the illness burden of osteoporosis. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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