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Osteoporosis International
Published in: Osteoporosis International 6/2017

01-06-2017 | Original Article

Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014

Authors: F. Cosman, J. H. Krege, A. C. Looker, J. T. Schousboe, B. Fan, N. Sarafrazi Isfahani, J. A. Shepherd, K. D. Krohn, P. Steiger, K. E. Wilson, H. K. Genant

Published in: Osteoporosis International | Issue 6/2017

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Abstract

Summary

Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them.

Introduction

Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data.

Methods

Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013–2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected.

Results

Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA.

Conclusion

Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.
Literature
1.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475CrossRefPubMed
2.
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29:1929–1937CrossRefPubMedPubMedCentral
3.
Ensrud KE, Thompson DE, Cauley JA et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. J Am Geriatr Soc 48:241–249CrossRefPubMed
4.
Lips P, Cooper C, Agnusdei D, et al. for the Working Party for Quality of Life of the European Foundation for Osteoporosis et al (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporos Int 10:150–160
5.
Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800CrossRefPubMed
6.
Sontag A, Krege JH (2010) First fractures among postmenopausal women with osteoporosis. J Bone Miner Metab 28:485–488CrossRefPubMed
7.
Ferrar L, Roux C, Felsenberg D, Glüer CC, Eastell R (2012) Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS). Osteoporos Int 23:59–65CrossRefPubMed
8.
McCloskey EV, Vasireddy S, Threlkeld J et al (2008) Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 23:1561–1568CrossRefPubMed
9.
US Department of Health and Human Services (2004) Bone health and osteoporosis: a report of the surgeon general. US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, Rockville, MD
10.
11.
Watts NB, Bilezikian JP, Camacho PM et al (2010) American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 16(suppl 3):1–37CrossRefPubMedPubMedCentral
12.
Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y, On behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57CrossRefPubMed
13.
Melton LJ III, Lane AW, Cooper C, Eastell R, O’Fallon WM, Riggs BL (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3:113–119CrossRefPubMed
14.
Davies KM, Stegman MR, Heaney RP, Recker RR (1996) Prevalence and severity of vertebral fracture: the Saunders County Bone Quality Study. Osteoporos Int 6:160–165CrossRefPubMed
15.
Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828CrossRefPubMed
16.
Samelson EJ, Hannan MT, Zhang Y, Genant HK, Felson DT, Kiel DP (2006) Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study. J Bone Miner Res 21:1207–1214CrossRefPubMed
17.
Schousboe JT, Rosen HR, Vokes TJ, Cauley JA, Cummings SR, Nevitt MC, Black DM, Orwoll ES, Kado DM, Ensrud KE, For the Osteoporotic Fractures in Men (MrOS) Study Research Group (2014) Prediction models of prevalent radiographic vertebral fractures among older men. J Clin Densitom 17:449–457CrossRefPubMed
18.
Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289CrossRefPubMed
19.
Hospers IC, van der Laan JG, Zeebregts CJ et al (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–828CrossRefPubMed
20.
Fuerst T, Wu C, Genant HK et al (2009) Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 20:1199–1205CrossRefPubMed
21.
Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71CrossRefPubMed
22.
Ferrar L, Jiang G, Schousboe JT, DeBold CR, Eastell R (2008) Algorithm-based qualitative and semiquantitative identification of prevalent vertebral fracture: agreement between different readers, imaging modalities, and diagnostic approaches. J Bone Miner Res 23:417–424CrossRefPubMed
23.
Vokes TJ, Dixon LB, Favus MJ (2003) Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int 14:871–878CrossRefPubMed
24.
Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668CrossRefPubMed
25.
Schousboe JT, Vokes T, Broy SB et al (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11:92–108CrossRefPubMed
26.
Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489CrossRefPubMed
27.
Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J (2013) National health and nutrition examination survey: plan and operations, 1999-2010. Vital Health Stat 1(56):1–37
28.
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMed
29.
30.
31.
Watts NB, Leslie WD, Foldes AJ, Miller PD (2013) 2013 International Society for Clinical Densitometry position development conference: Task Force on Normative Databases. J Clin Densitom 16:472–481CrossRefPubMed
32.
Wainwright SA, Marshall LM, Ensrud KE et al (2005) Study of Osteoporotic Fractures Research Group. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90:2787–2793CrossRefPubMed
33.
Jackson SA, Tenenhouse A, Robertson L, CaMos Study Group (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687CrossRefPubMed
34.
O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMed
35.
Middleton ET, Steel SA (2008) Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures. Osteoporos Int 19:1167–1173CrossRefPubMed
36.
Sanfélix-Genovés J, Reig-Molla B, Sanfélix-Gemeno G et al (2010) The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO Study). Bone 47:610–616CrossRefPubMed
37.
Kanterewicz E, Puigoriol E, García-Barrionuevo J, del Rio L, Casellas M, Peris P, Frodos Research Group (2014) Prevalence of vertebral fractures and minor vertebral deformities evaluated by DXA-assisted vertebral fracture assessment (VFA) in a population-based study of postmenopausal women: the FRODOS study. Osteoporos Int 25:1455–1464PubMed
38.
Fujiwara S, Hamaya E, Goto W et al (2011) Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk in Japan. Bone 49:520–525CrossRefPubMed
39.
Ismail AA, Cooper C, Felsenberg D et al (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporos Int 9:206–213CrossRefPubMed
40.
Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of vertebral fractures. Osteoporos Int 15:887–896CrossRefPubMed
41.
Oei L, Rivandeira F, Ly F, Breda SJ, Zillikens MC, Hoffman A, Utterlinden AG, Krestin GP, Oei EHG (2013) A review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings. Eur Radiol 23:476–486CrossRefPubMed
42.
43.
Stevens JA, Anne Rudd R (2010) Declining hip fracture rates in the United States. Age Ageing 39:500–503CrossRefPubMed
44.
Wright NC, Saag KG, Curtis JR et al (2012) Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res 27:2325–2332CrossRefPubMed
45.
Yu W, Lin Q, Zhou X, Shao H, Sun P (2014) Reconsideration of the relevance of mild wedge or short vertebral height deformities across a broad age distribution. Osteoporosis Int 25:2609–2615CrossRef
46.
Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporosis Int 18:761–770CrossRef
47.
48.
Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–192CrossRefPubMed
49.
Siris ES, Adler R, Bilezikian J et al (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443CrossRefPubMedPubMedCentral
50.
Van Staa TP, Laan RF, Barton IP et al (2003) Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48:3224–3229CrossRefPubMed
51.
Domiciano DS, Figueiredo CP, Lopes JB, Kuroishi ME, Takayama L, Caparbo VF, Fuller P, Menezes PR, Scazufca M, Bonfa E, Pereira RMR (2013) Vertebral fracture assessment by dual X-ray absorptiometry: a valid tool to detect vertebral fractures in community-dwelling older adults in a population-based survey. Arthritis Care & Res 65:809–815CrossRef
52.
Zimmerman SI, Girman CJ, Buie VC et al (1999) The prevalence of osteoporosis in nursing home residents. Osteoporos Int 9:151–157CrossRefPubMed
Metadata
Title
Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014
Authors
F. Cosman
J. H. Krege
A. C. Looker
J. T. Schousboe
B. Fan
N. Sarafrazi Isfahani
J. A. Shepherd
K. D. Krohn
P. Steiger
K. E. Wilson
H. K. Genant
Publication date
01-06-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-017-3948-9

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