Osteoporosis International

, Volume 14, Issue 6, pp 520–524 | Cite as

The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population

  • M. Naves
  • J. B. Díaz-López
  • C. Gómez
  • A. Rodríguez-Rebollar
  • M. Rodríguez-García
  • J. B. Cannata-Andía
Original Article


There is little data concerning the morbidity, mortality, and epidemiology of vertebral fracture. The aim of this study was to evaluate the effect of prevalent and incident vertebral fractures as risk factors for further osteoporotic fractures and mortality. The study was performed on a cohort of 316 women and 308 men older than 50 belonging to the EVOS study, randomly selected from our city register. At the beginning of the study and 4 years later, lateral dorsal and lumbar X-rays were performed. In addition, evaluation of the incidence of osteoporotic nonvertebral fractures was performed throughout 8 years. The incidence of all osteoporotic fractures was higher in women than in men (two-fold increase in vertebral fracture incidence and five-fold increase in Colles' and femur incidence). Vertebral fracture was a strong risk factor for a new vertebral fracture [RR=4.7 (1.8–11.9)], hip fracture [RR=6.7 (2.0–22.7)] and Colles' fracture [RR=3.0 (1.1–7.8)]. Prevalent and incident vertebral fractures were associated with a higher risk of having a hip fracture [RR=10.0 (2.0–50.2)] and Colles' fracture [RR=5.5 (1.3–23.4)]. In addition, in women, the vertebral fracture was associated with a higher mortality. By contrast, no association was found in men. These results demonstrate the association between a previous vertebral fracture with increments in the incidence of osteoporotic fractures of any type. In addition, we found a significantly higher mortality rate in women having vertebral fractures. These findings support the necessity of preventing the occurrence of vertebral fractures to limit their strong negative impact on mortality.


Incidence Mortality Osteoporosis Prevalence Vertebral fracture 



This study has been partly supported by the European Vertebral Osteoporosis Study (EVOS) of the European Community (1991–1993), by the European Prospective Osteoporosis Study (EPOS) of the European Community, BIOMED 1993–1995, BMHI-CT 092-0182 (1993−1997), by Fondo de Investigaciones Sanitarias (FIS 94/1901-E), and by Fundación Renal Iñigo Alvarez de Toledo (Spain). The authors wish to thank Dr J. R. Jiménez Blanco (department of radiology) for technical support.


  1. 1.
    Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III (1992). Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7(2):221–227Google Scholar
  2. 2.
    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(7):1010–1018Google Scholar
  3. 3.
    Naves Diaz M, Diaz Lopez JB, Gomez Alonso C, Altadill Arregui A, Rodriguez Rebollar A, Cannata Andia JB (2000) [Study of incidence of osteoporotic fractures in a cohort of individuals older than 50 years from Asturias, Spain, after a 6 year follow-up period]. Med Clin (Barc) 115(17):650–653Google Scholar
  4. 4.
    Melton LJ III, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221Google Scholar
  5. 5.
    Lauritzen JB, Lund B (1993) Risk of hip fracture after osteoporosis fractures: 451 women with fracture of lumbar spine, olecranon, knee or ankle. Acta Orthop Scand 64(3):297–300Google Scholar
  6. 6.
    Kotowicz MA, Melton LJ III, Cooper C, Atkinson EJ, O'Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9(5):599–605Google Scholar
  7. 7.
    Gunnes M, Mellstrom D, Johnell O (1998) How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal women. Acta Orthop Scand 69(5):508–512Google Scholar
  8. 8.
    Naves Diaz M, Diaz Lopez JB, Rodriguez Rebollar A, Gomez Alonso C, Diaz Corte C, Cannata Andia J (2001) [Effect of vertebral fracture on health related quality of life in a Spanish population older than 54 years]. Med Clin (Barc) 116(14):533–535Google Scholar
  9. 9.
    Ismail AA, O'Neill TW, Cooper C, et al (1998) Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 8(3):291–297Google Scholar
  10. 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(11):1215–1220Google Scholar
  11. 11.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148Google Scholar
  12. 12.
    Diaz Lopez JB, Naves Diaz M, Gomez Alonso C, Fernandez Martin JL, Rodriguez Rebollar A, Cannata Andia JB (2000) [Prevalence of vertebral fracture in population older than 50 years in Asturias (Spain) defined following different radiological criteria]. Med Clin (Barc) 115(9):326–331Google Scholar
  13. 13.
    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ III (1991) Classification of vertebral fractures. J Bone Miner Res 6(3):207–215Google Scholar
  14. 14.
    McCloskey EV, Spector TD, Eyres KS, et al (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3(3):138–147Google Scholar
  15. 15.
    Black DM, Cummings SR, Stone K, Hudes E, Palermo L, Steiger P (1991) A new approach to defining normal vertebral dimensions. J Bone Miner Res 6(8):883–892Google Scholar
  16. 16.
    Gardsell P, Johnell O, Nilsson BE, Nilsson JA (1989) The predictive value of fracture, disease, and falling tendency for fragility fractures in women. Calcif Tissue Int 45(6):327–30Google Scholar
  17. 17.
    Burger H, van Daele PL, Algra D, et al (1994) Vertebral deformities as predictors of non-vertebral fractures. BMJ 309(6960):991–992Google Scholar
  18. 18.
    Ismail AA, Cockerill W, Cooper C, et al (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12(2):85–90Google Scholar
  19. 19.
    Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14(5):821–828Google Scholar
  20. 20.
    O'Neill TW, Cooper C, Finn JD, et al (2001) Incidence of distal forearm fracture in British men and women. Osteoporos Int 12(7):555–558Google Scholar
  21. 21.
    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(11):919–923Google Scholar
  22. 22.
    Lindsay R, Silverman SL, Cooper C, et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323Google Scholar
  23. 23.
    Eastell R (1996) Forearm fracture. Bone 18(3 Suppl):203S–207SGoogle Scholar
  24. 24.
    Cuddihy MT, Gabriel SE, Crowson CS, O'Fallon WM, Melton LJ III (1999) Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int 9(6):469–475Google Scholar
  25. 25.
    Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005Google Scholar
  26. 26.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882Google Scholar
  27. 27.
    Cummings SR, Nevitt MC, Browner WS, et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332(12):767–773Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • M. Naves
    • 1
  • J. B. Díaz-López
    • 1
  • C. Gómez
    • 1
  • A. Rodríguez-Rebollar
    • 1
  • M. Rodríguez-García
    • 1
  • J. B. Cannata-Andía
    • 1
  1. 1.Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, Hospital Universitario Central de AsturiasUniversidad de OviedoOviedo Spain

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