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Vertebral fracture prevalence in black and white South African women

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Abstract

Summary

Black women are generally regarded as being less prone to the development of osteoporosis. This study reports a similar prevalence of morphometric vertebral fractures in black (9.1 %) and white (5.0 %) South African women. Clinical risk factors and bone strength parameters contributed differently to fracture risk in the two ethnic cohorts.

Purpose

Vertebral fracture represents one of the most common osteoporotic fractures and is a significant cause of morbidity and mortality. Little is known regarding the prevalence of vertebral fractures on the African continent. We therefore prospectively examined the prevalence of vertebral fracture on radiographs of the thoraco-lumbar spine in otherwise healthy community-dwelling older black and white South African women.

Methods

Radiographs of the spine (T4–L5) were obtained randomly in 189 women (47 % black), aged 40 years or older, for the analysis of vertebral fracture. Radiographs were evaluated by a single radiologist, blinded to clinical data, using Genant’s semi-quantitative method. Clinical risk factors for osteoporosis, risk factors for falls (fall history, quadriceps strength, lateral sway and reaction time), areal and volumetric bone mineral density of the spine and hip, calcaneal ultrasonography (QUS) and vertebral macro-geometry were assessed in the two ethnic groups and the association with prevalent vertebral fractures examined.

Results

Vertebral fracture prevalence in older South African black and white women was similar (9.1 % in black and 5.0 % in white women). In black women, lower body weight and lower areal and volumetric bone mineral density (BMD) at all sites could serve as markers of increased fracture risk. Older age, physical inactivity, lower muscle strength and lower femoral BMD were associated with vertebral fracture risk in whites.

Conclusion

Our findings are noteworthy and the first attempt to compare vertebral fracture risk in women of different ethnicities on the African continent. A similar vertebral fracture risk between black and white women in South Africa must be considered at present to ensure appropriate evaluation in all subjects who present with clinical risk factors for osteoporosis, regardless of ethnicity.

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Acknowledgments

This work was supported by grants from the Medical Research Council of South Africa and the Women’s Health Initiative Indianapolis. We thank Madele du Plessis for performing the dietary analyses.

Authors’ contributions

SH and MC were responsible for the study design, data collection, data interpretation and revision of manuscript content. MC was also responsible for the study conduct, data analysis and drafting the manuscript. MK was also responsible for the data analysis and data interpretation. MMC and ATS were also responsible for data collection. SH, MMC, ATS, MK and SH were responsible for approving the final version of manuscript. MC takes responsibility for the integrity of the data analysis.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of Stellenbosch, P.O. Box 241, Cape Town, 8000, South Africa

    Magda Conradie, Maria M. Conradie & Stephen Hough

  2. Department of Radiology, Faculty of Health Sciences, University of Stellenbosch, P.O. Box 241, Cape Town, 8000, South Africa

    Alan T. Scher

  3. Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa

    Martin Kidd

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  1. Magda Conradie
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  2. Maria M. Conradie
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Correspondence to Magda Conradie.

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Conradie, M., Conradie, M.M., Scher, A.T. et al. Vertebral fracture prevalence in black and white South African women. Arch Osteoporos 10, 1 (2015). https://doi.org/10.1007/s11657-015-0203-x

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