Abstract
Summary
Data are still scarce regarding the prevalence and the associated factors of vertebral fractures (VF) in the North Africa and the Middle East region. In this study, VF were common in at risk Tunisian women with a prevalence of 26.19%. Lower total hip T-score, having severe back pain, and being physically inactive were independently associated with VF.
Introduction
Vertebral fractures are related to a marked increase in morbidity and mortality and they are associated with a definite risk of subsequent fracture. Nevertheless, they remain underdiagnosed and little is known about their epidemiology in the African countries. In this first Tunisian study, we aimed to assess the prevalence and the associated factors of asymptomatic VF among at risk Tunisian post-menopausal women.
Methods
In this cross-sectional study, we included post-menopausal women without a previous diagnosis of VF and who were referred for bone mineral density (BMD) measurement. Each participant had had an extensive medical history investigation, a BMD assessment, and a vertebral fracture assessment (VFA) scan using a dual energy X-ray absorptiometry. VF were defined using Genant semi-quantitative method.
Results
Two hundred and ten post-menopausal women were included. The overall prevalence of VF was 26.19% and 9.52% of our participants had multiple VF. The prevalence of VF was significantly higher in older participants, those having a history of prior severe fragility fracture, or having at least one intrinsic fall. The percentage of low bone mineral density and osteoporosis were significantly higher in women with VF. After binary logistic regression analysis, severe back pain (OR = 3.016; 95% CI 1.304–6.974), regular physical activity (OR = 0.065; 95% CI 0.02–0.213), and total hip T-score (OR = 0.56; 95% CI 0.383–0.820) were independently associated with VF.
Conclusion
VF are very prevalent among at risk Tunisian post-menopausal women and their incorporation in a clinical and densitometric tool might identify more effectively subsequent fracture.
Similar content being viewed by others
References
Kado DM, Duong T, Nevitt MC, Greendale GA, Cummings SR, Stone KL et al (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 14:589–594
Kaptoge S, Armbrecht G, Felsenberg D, Lunt M, Weber K, Boonen S et al (2006) Whom to treat? The contribution of vertebral X-rays to risk-based algorithms for fracture prediction. Results from the European Prospective Osteoporosis Study. Osteoporos Int 17:1369–81
Riggs BL, Melton LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S-511S
Zeytinoglu M, Jain RK, Vokes TJ (2017) Vertebral fracture assessment: enhancing the diagnosis, prevention, and treatment of osteoporosis. Bone 104:54–65
Roux C, Baron G, Audran M, Breuil V, Chapurlat R, Cortet B et al (2011) Influence of vertebral fracture assessment by dual-energy X-ray absorptiometry on decision-making in osteoporosis: a structured vignette survey. Rheumatol Oxf Engl 50:2264–2269
Middleton ET, Steel SA (2008) Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures. Osteoporos Int 19:1167–1173
Schousboe JT (2018) Vertebral fracture identification as part of a comprehensive risk assessment in patients with osteoporosis. Curr Osteoporos Rep 16:573–583
Sellami S, Sahli H, Meddeb N, Hamza S, Chahed M, Ben M’Barek R et al (2006) Prevalence of osteoporotic fractures in Tunisian women. Rev Chir Orthop Reparatrice Appar Mot 92:490–4
Fixed Risk Factors | International Osteoporosis Foundation [Internet]. [cited 16 Sept 2020]. Available on: http://iofbonehealth.net/fixed-risk-factors
Rosen HN, Vokes TJ, Malabanan AO, Deal CL, Alele JD, Olenginski TP et al (2013) The official positions of the International Society for Clinical Densitometry: vertebral fracture assessment. J Clin Densitom 16:482–488
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
McCloskey EV, Johansson H, Oden A, Kanis JA (2009) From relative risk to absolute fracture risk calculation: the FRAX algorithm. Curr Osteoporos Rep 7:77–83
Yang J, Mao Y, Nieves JW (2020) Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: a systematic review and meta-analysis. Bone 136:115358
El Maghraoui A, Morjane F, Nouijai A, Achemlal L, Bezza A, Ghozlani I (2009) Vertebral fracture assessment in Moroccan women: prevalence and risk factors. Maturitas 62:171–175
Diacinti D, Guglielmi G, Pisani D, Diacinti D, Argirò R, Serafini C et al (2012) Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). Radiol Med (Torino) 117:1374–1385
El Hage R, Khairallah W, Bachour F, Issa M, Bedran F, Zakhem E et al (2014) Is obesity protective against vertebral deformities in Lebanese women? J Clin Densitom 17:433–434
Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BHR, Slart RHJA (2011) Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int 22:1059–1068
Utamakul C, Sritara C, Bhumiwat M, Bua-ngam C, Sriudomporn K, Promma S et al (2016) Unsuspected vertebral fracture in older women undergoing screening bone mineral density assessment: prevalence, impact, and agreement with lateral spine radiography. Eur Geriatr Med 7:551–555
El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I (2013) Systematic vertebral fracture assessment in asymptomatic postmenopausal women. Bone 52:176–180
Baddoura R, Arabi A, Haddad-Zebouni S, Khoury N, Salamoun M, Ayoub G et al (2007) Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis. Bone 40:1066–1072
Middleton ET, Gardiner ED, Steel SA (2009) Which women should be selected for vertebral fracture assessment? Comparing different methods of targeting VFA. Calcif Tissue Int 85:203–210
Shetty S, John B, Mohan S, Paul TV (2020) Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis. Arch Osteoporos 15:25
Greendale GA, Wilhalme H, Huang M-H, Cauley JA, Karlamangla AS (2016) Prevalent and incident vertebral deformities in midlife women: results from the Study of Women’s Health Across the Nation (SWAN). PloS One 11:e0162664
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 11:1010–1018
Clark P, Cons-Molina F, Deleze M, Ragi S, Haddock L, Zanchetta JR et al (2009) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 20:275–282
Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624
Johansson H, Odén A, McCloskey EV, Kanis JA (2014) Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures. Osteoporos Int 25:235–241
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 11:660–668
Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L et al (2014) Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 25:2805–15
Kanterewicz E, Puigoriol E, Rodríguez Cros JR, Peris P (2019) Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int 30:2141–2149
Domiciano DS, Figueiredo CP, Lopes JB, Kuroishi ME, Takayama L, Caparbo VF et al (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 65:809–815
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. Osteoporos Int 25:2609–2615
Reniu AC, Ong T, Ajmal S, Sahota O (2017) Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: experience of a UK Fracture Liaison Service. Arch Osteoporos 12:23
Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Menezes PR, Scazufca M et al (2011) Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly. Osteoporos Int 22:711–719
Roux C, Priol G, Fechtenbaum J, Cortet B, Liu-Léage S, Audran M (2007) A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain. Ann Rheum Dis 66:81–85
Waterloo S, Søgaard AJ, Ahmed LA, Damsgård E, Morseth B, Emaus N (2013) Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007–08. BMC Geriatr 13:102
Schneider J, Bundschuh B, Späth C, Landkammer C, Müller H, Sommer U et al (2004) Discrimination of patients with and without vertebral fractures as measured by ultrasound and DXA osteodensitometry. Calcif Tissue Int 74:246–254
Vokes TJ, Gillen DL, Lovett J, Favus MJ (2005) Comparison of T-scores from different skeletal sites in differentiating postmenopausal women with and without prevalent vertebral fractures. J Clin Densitom 8:206–215
Malgo F, Hamdy NAT, Ticheler CHJM, Smit F, Kroon HM, Rabelink TJ et al (2017) Value and potential limitations of vertebral fracture assessment (VFA) compared to conventional spine radiography: experience from a fracture liaison service (FLS) and a meta-analysis. Osteoporos Int. 28:2955–65
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Informed consent
Informed consent was obtained from all individual participants included in the study.
Consent for publication
Consent for publication was obtained from all authors. STATA 15.0 software was used for statistical analysis.
Conflicts of interest
None.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
El Amri, N., Daldoul, C., Lataoui, S. et al. Asymptomatic vertebral fracture in Tunisian post-menopausal women at risk: prevalence and risk factors. Arch Osteoporos 16, 139 (2021). https://doi.org/10.1007/s11657-021-00989-4
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-021-00989-4