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Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients

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Abstract

Summary

In a prospective cohort study of 395 geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline. The mortality risk was independently associated with the presence of three or more vertebral fractures at baseline. In the surviving patients, the risk of incident fractures was noteworthy, occurring in 26 % of these patients.

Introduction

The purpose of this study is to determine mortality rate and the incidence of vertebral fractures in a geriatric outpatient group, during a 3-year follow-up period, in a teaching hospital in Amsterdam, The Netherlands.

Methods

This study includes a prospective cohort study of 395 geriatric patients who had their baseline visit at a diagnostic day hospital in 2007 and 2008. They were invited for follow-up 3 years later. Lateral X-rays of the lumbar spine and chest were performed at baseline and after 3 years; vertebral fractures were scored in all patients according to the semi-quantitative method of Genant.

Results

After 3 years, mortality was 46 % and associated with prevalent vertebral fractures at baseline (odds ratio (OR), 1.83; 95 % CI, 1.23–2.74). The presence of three or more vertebral fractures at baseline was an independent risk factor for mortality (OR, 3.32; 95 % CI, 1.56–7.07). Other independently associated risk factors were greater age, higher co-morbidity score, and having more prescriptions. Higher cognitive capacity protected against mortality after 3 years. In 72 patients, radiography was repeated. Nineteen patients (26 %) had an incident radiographic vertebral fracture: 16 in those with a prevalent fracture, and 3 in those without a prevalent vertebral fracture at baseline.

Conclusions

In geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline, and the mortality risk was independently associated with 3 or more vertebral fractures at baseline. In survivors, the risk of incident fractures was noteworthy, since these occurred in 26 % of the patients, particularly in those with a prevalent vertebral fracture.

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References

  1. Melton LJ 3rd, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporosis Int 10:214–221

    Article  Google Scholar 

  2. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  PubMed  CAS  Google Scholar 

  3. der Jagt-Willems V, van Hengel M, Vis M et al (2012) Why do geriatric patients have so many vertebral fractures? Exploring prevalence and riskfactors. Age Ageing 41:200–206

    Article  PubMed  Google Scholar 

  4. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC et al (1996) Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541

    Article  PubMed  CAS  Google Scholar 

  5. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: result from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645

    Article  PubMed  CAS  Google Scholar 

  6. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral efficacy with Risedronate Therapy (VERT) Study Group. Osteoporosis Int 11:83–91

    Article  CAS  Google Scholar 

  7. Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C et al (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Periferal Osteoporosis (TROPOS) Study. J Clin Endocrinol Metab 90:2816–2822

    Article  PubMed  CAS  Google Scholar 

  8. Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–42S

    Article  PubMed  CAS  Google Scholar 

  9. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. Trone DW, Kritz-Silverstein D, Von Muhlen DG, Wingard DL, Barrett-Connor E (2007) Is radiographic vertebral fracture a risk factor for mortality? Am J Epidemiol 166:1191–1197

    Article  PubMed  Google Scholar 

  12. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521

    Article  PubMed  CAS  Google Scholar 

  13. Charlson ME, Pompei P, Ales K, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  14. De Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56:221–229

    Article  PubMed  Google Scholar 

  15. Podsiadlo D, Richardson S (1991) The timed up and go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    PubMed  CAS  Google Scholar 

  16. Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probabillity for falls in community-dwelling older adults using the timed up & go test. Phys Ther 80:896–903

    PubMed  CAS  Google Scholar 

  17. Folstein MF, Robins LN, Helzer JE (1983) The mini-mental state examination. Arch Gen Psychiatry 40:812

    Article  PubMed  CAS  Google Scholar 

  18. Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O 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). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporosis Int 10:150–160

    Article  CAS  Google Scholar 

  19. van Marwijk HWJ, Wallace P, De Bock GH, Hernans JO, Kaptein AA, Mulder JD (1995) Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract 45:195–199

    PubMed  Google Scholar 

  20. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M46–M56

    Article  Google Scholar 

  21. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  22. Black DM, Palermo L, Nevitt MC et al (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902

    Article  PubMed  CAS  Google Scholar 

  23. Grados F, Roux C, de Vernejoul MC, Utard G, Sebert JL, Fardellone P (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722

    Article  PubMed  CAS  Google Scholar 

  24. Statline (2007). http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLNL&PA=70701NED&D1=85&D2=a&D3=83&D4=57&HD=120622-0916&HDR=G1,T&STB=G2,G3

  25. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  PubMed  CAS  Google Scholar 

  26. Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 20:1349–1355

    Article  PubMed  Google Scholar 

  27. Tosteson AN, Gottlieb DJ, Radley DC, Fisher ES, Melton LJ 3rd (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18:1463–1472

    Article  PubMed  CAS  Google Scholar 

  28. Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Study of osteoporotic fractures research group. Non-trauma mortality in elderly women with low bone mineral density. Lancet 338:355–358

    Article  PubMed  CAS  Google Scholar 

  29. Kado DM, Duong T, Stone KL et al (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 14:589–594

    Article  PubMed  CAS  Google Scholar 

  30. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA et al (2007) Frailty and risk of falls, fracture and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med 62:744–751

    Article  Google Scholar 

  31. Ismail AA, O’Neill TW, Cooper C, Finn JD, Bhalla AK, Cannata JB et al (1998) Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 8:291–297

    Article  PubMed  CAS  Google Scholar 

  32. Ensrud KE, Thompson DE, Cauley JA et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48:241–249

    PubMed  CAS  Google Scholar 

  33. Bruyere O, Roux C, Nicolet D et al (2012) Severity of incident vertebral fracture and future fracture risk: a 3 year prospective study. Abstract OC6 on ECCEO

  34. Posthuma WF, Westendorp RG, Vandenbroucke JP (1994) Cardioprotective effect of hormone replacement therapy in postmenopausal women: is the evidence biased? BMJ 308:1268–1269

    Article  PubMed  CAS  Google Scholar 

  35. Netelenbos JC, Geusens PP, Ypma G, Buijs SJ (2011) Adherence and profile of non-persistence in patients treated for osteoporosis—a large scale, longterm retrospective study in the Netherlands. Osteoporosis Int 22:1537–1546

    Article  CAS  Google Scholar 

  36. Inderjeeth CA, Foo AC, Lai MM, Glendenning P (2009) Efficacy and safety of pharmacological agents in managing osteoporosis in the old: review of the evidence. Bone 44:744–751

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Geriatrics, Slotervaart Hospital, Amsterdam, The Netherlands

    H. C. van der Jagt-Willems, C. R. Tulner & J. P. C. M. van Campen

  2. Department Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands

    H. C. van der Jagt-Willems

  3. Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands

    M. Vis

  4. Department of Rheumatology, Royal Cornwall Hospital, Truro, UK

    A. D. Woolf

  5. Academic Medical Center, Department of Internal Medicine, Amsterdam, The Netherlands

    B. C. van Munster

  6. Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands

    B. C. van Munster

  7. Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands

    W. F. Lems

  8. Internal Medicine and Geriatrics, Spaarne Hospital, Spaarnepoort 1, 2134, TM, Hoofddorp, The Netherlands

    H. C. van der Jagt-Willems

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  1. H. C. van der Jagt-Willems
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Correspondence to H. C. van der Jagt-Willems.

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van der Jagt-Willems, H.C., Vis, M., Tulner, C.R. et al. Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients. Osteoporos Int 24, 1713–1719 (2013). https://doi.org/10.1007/s00198-012-2147-y

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  • DOI: https://doi.org/10.1007/s00198-012-2147-y

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