Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: A 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study

Abstract

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50-80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6-3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3-4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4-5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1-2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1-3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7-5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.

Osteoporosis and fractures in systemic lupus erythematosus

“…However, studies focusing on symptomatic fractures have a disadvantage in that only one-third of all vertebral fractures come to clinical attention (46). Identifying prevalent vertebral fractures is important, since prevalent vertebral deformities are associated with reduced quality of life (47), an increased mortality rate, and an increased risk of future fractures in the general population (48).…”

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

“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Vertebral fracture and cause-specific mortality: a prospective population study of 3,210 men and 3,730 women with 30 years of follow-up

“…These fractures are estimated to affect at least 20% of the elderly population [1][2][3]; however, only 30-40% of these come to clinical attention [4,5]. Vertebral fractures have been associated with increased mortality in several studies [6][7][8][9][10][11][12][13], but obvious associations with specific causes of death have so far not been reported. Increased mortality has also been found to be independently associated with low bone mineral density without fractures [14][15][16].…”

“…Deaths from cardiovascular diseases in men and malignant neoplasms and respiratory diseases in men and women have been suggested to explain the excess mortality in subjects with vertebral fracture [9,11,13], whereas low bone mineral density has been linked with increased risk of stroke and also with mortality from natural causes other than cardiovascular diseases [14][15][16]. Vertebral fractures are known to predict the risk of subsequent hip fracture [17][18][19], but associations with deaths due to injuries have not been reported.…”