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Open Access 18-01-2024 | Osteoporosis | Original Article

Opportunistically identifiable vertebral fractures on routine radiological imaging predict mortality: observational cohort study

Authors: Michael Kriegbaum Skjødt, Joeri Nicolaes, Christopher Dyer Smith, Kim Rose Olsen, Cesar Libanati, Cyrus Cooper, Bo Abrahamsen

Published in: Osteoporosis International | Issue 4/2024

Abstract

Summary

In men and women with opportunistically identifiable vertebral fractures (VFs) on routine CT scans including the chest and/or abdomen, the risk of death is 51% higher than in those with no VF on the CT scan, and 325% higher than an age- and sex-matched general population cohort.

Purpose

There is little knowledge about the risk of death in patients with VFs present on routine radiological imaging. We evaluated the risk of death in men and women aged 50 years or older with opportunistically identifiable VFs on routine CT scans and not treated with osteoporosis medications.

Methods

Thoracic and lumbar VFs were identified through a blinded, two-step approach on CT scans performed as part of normal clinical care in a Danish hospital in 2010 or later. Subjects with VF were matched on age and sex against those with no VF (1:2-ratio) and a general population cohort (1:3-ratio), respectively, and followed for up to 7 years through the national Danish registers. Subjects treated with an osteoporosis medication in the year prior to baseline were excluded.

Results

Subjects with VF had a significantly higher risk of death during follow-up as compared to subjects with no VF on the CT scan (adjusted hazard ratio [HR] 1.51 [95% confidence interval 1.27–1.79; p < 0.001]) and even more so when compared to the general population cohort (HR 4.25 [3.53–5.12; p < 0.001]). In subjects with versus without VF on the CT scan, the risk was higher in those with moderate or severe VF, in those with no malignancy prior to baseline, and in those with a lower Charlson comorbidity index score.

Conclusion

Subjects with VF available for identification on routine CT scans face a substantially increased risk of death. Opportunistic identification and reporting of VF is important to identify these patients to allow intervention if indicated.

Available only for authorised users

Baseline covariates applied in the selection procedure: History of any prior fracture (except face, skull, and fingers), osteoporosis, Paget’s disease, any malignancy, benign tumours, hyperthyroidism, primary hyperparathyroidism, Cushing’s syndrome, hypogonadism, acromegaly, Addison’s disease, monogenetic osteoporosis, anorexia nervosa, bulimia, malabsorptive diseases, inflammatory bowel disease, pernicious anaemia, Bechterew’s disease (ankylosing spondylitis), mastocytosis, systemic lupus erythematosus, juvenile arthritis, rheumatoid arthritis, myelomatosis, type 1 diabetes mellitus, type 2 diabetes mellitus, and any prior use of sodium glucose cotransporter-2 (SGLT-2) inhibitors, thiazolidinediones, glucocorticoids, anticoagulants, antidepressants, cancer agents, antiepileptics, GnRH agonists, and proton pump inhibitors.

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Title: Opportunistically identifiable vertebral fractures on routine radiological imaging predict mortality: observational cohort study
Authors: Michael Kriegbaum Skjødt
Joeri Nicolaes
Christopher Dyer Smith
Kim Rose Olsen
Cesar Libanati
Cyrus Cooper
Bo Abrahamsen
Publication date: 18-01-2024
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 4/2024
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-024-07017-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Opportunistically identifiable vertebral fractures on routine radiological imaging predict mortality: observational cohort study

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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