Abstract
Summary
The relationship between prevalent vertebral fractures and new vertebral fractures in Korean women has not been previously studied. We found that prevalent vertebral fracture is a strong risk factor for subsequent radiographic vertebral fracture, independent of age and spine bone mineral density (BMD) in postmenopausal Korean women receiving antiresorptive agents.
Introduction
The presence of prevalent vertebral fractures increases the risk of subsequent vertebral fractures. This observational study examined whether prevalent vertebral fractures influenced future incident vertebral fracture in postmenopausal women receiving antiresorptive treatment.
Methods
Using the medical records, we retrospectively assessed 1,200 postmenopausal women who had visited the osteoporosis clinic. Among them, we selected patients whose BMD was measured at least once a year for 3 years. We excluded patients whose lateral spine X-ray film at baseline or follow-up period was missing, which is the key assessment. In the end, we analyzed 666 postmenopausal women. The mean duration of follow-up period was 3.2 years.
Results
The majority of patients (83%) received bisphosphonates or raloxifene during the mean duration of 3.2 years. Fifty-five of the 666 women had new incident radiographic vertebral fractures during the follow-up period. Prevalent vertebral fractures were associated with a five-fold increased risk (odd ratio 5.7, 95% CI 3.09–10.74) of incident vertebral fractures after adjusting for age. These associations remained significant after the adjustment for multiple confounding factors (odd ratio 4.4, 95% CI 1.97–9.75). The risk of incident vertebral fracture increased with the number of prevalent vertebral fractures at baseline: 3.4 (95% CI 1.54–7.70) for those with a single fracture and 7.4 (95% CI 3.10–17.54) for those with two or more after adjustment for age and spine BMD.
Conclusions
We confirmed that prevalent vertebral fracture is a strong risk factor for new vertebral fractures, independent of age and spine BMD in postmenopausal Korean women receiving antiresorptive agents.
Similar content being viewed by others
References
Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103(suppl):30S–43S
Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of osteoporotic fractures research group. Arch Intern Med 159:1215–1220
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Linsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Johnell O, Oden A, Caulin F, Kanis JA (2001) Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporosis Int 12:207–214
Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923
Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382
Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral fractures but not wrist fractures. Study of osteoporotic fracture research group. J Bone Miner Res 14:821–828
Lunt M, O'Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513
Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770
Katowics MA, Melton LJ III, Copper C, Atkinson EJ, O'fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605
National Osteoporosis Foundation (2005) Physician guide to prevention and treatment of osteoporosis. Available at http://www.nof.org/physguide/index.htm. Accessed January 15, 2005
Delmas PD, Rizzoli R, Cooper C, Reginster JY (2005) Treatment of patients with postmenopausal osteoporosis is worthwhile. The position of the International Osteoporosis Foundation. Osteoporos Int 16:1–5
Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194
Genant HK, Wu CY, Van Kuijk C, Nevitt M (1993) Vertebral fracture assessment using a SQ technique. J Bone Miner Res 8:1137–1148
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739
Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541
Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Eriksen BJ, EF HMS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352
Chesnut CH III, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, Felsenberg D, Huss H, Gilbride J, Schimmer RC, Delmas PD (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249
Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, Lacroix AZ (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures. Results from the Fracture Intervention Trial. JAMA 280:2077–2082
Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645
Lee SH, Khang YH, Lim KH, Kim BJ, Koh JM, Kim GS, Kim H, Cho NH (2010) Clinical risk factors for osteoporotic fracture: a population-base prospective cohort study in Korea. J Bone Miner Res 25:369–378
Grimes DA, Schulz KF (2009) Bias and causal associations in observational research. Lancet 359:248–252
Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E, Adachi JD (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, S.H., Choi, H.S., Rhee, Y. et al. Prevalent vertebral fractures predict subsequent radiographic vertebral fractures in postmenopausal Korean women receiving antiresorptive agent. Osteoporos Int 22, 781–787 (2011). https://doi.org/10.1007/s00198-010-1298-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-010-1298-y