Calcified Tissue International

, Volume 76, Issue 4, pp 235–242 | Cite as

Long-Term Morbidity and Mortality After a Clinically Diagnosed Vertebral Fracture in the Elderly—a 12- and 22-Year Follow-up of 257 Patients

  • R. Hasserius
  • M.K. Karlsson
  • B. Jónsson
  • I. Redlund-Johnell
  • O. Johnell
Article

Abstract

The objective of this study was to analyze the long-term morbidity and mortality in patients with a clinically diagnosed vertebral fracture. Seventy men with a mean age of 70 years (range 50–91 years) and 187 women with a mean age of 72 years (range 50–96 years) were radiographically diagnosed as having a vertebral fracture in the thoracic or lumbar spine at the Malmö University Hospital (Sweden) during 1979. At the time of a follow-up examination 12 years later, 56 of the 76 patients who were still alive participated in an investigation that evaluated back pain and subjective health status by a questionnaire. Forty-four of these subjects also participated in a further radiologic examination of the spine. Serving as controls were age- and gender-matched subjects from the Malmö cohort of the European Vertebral Osteoporosis Study (EVOS). A mortality analysis was also conducted, covering 22 years following the baseline fracture. There were more female patients, who, in comparison with the controls, 12 years after the diagnosis, had had back pain during the year preceding the follow-up (72% vs 33%, P < 0.001), had current back pain (42% vs. 19%, P = 0.006), and had a subjectively impaired health status (44% vs. 17%, P < 0.001). The corresponding differences in men reached only a borderline significance, for both back pain during the year preceding the follow-up (60% vs. 28%, P = 0.07) and current back pain (40% vs. 15%, P = 0.09), whereas there was no difference in subjective health status. The incidence of new vertebral fractures in individuals with a clinically diagnosed vertebral fracture during the following 12 years was in men 25 per 1,000 person-years and in women 49 per 1000 person-years. There were more women with a new vertebral fracture at the 12-year follow-up examination who, in comparison with women without a new fracture, had had back pain during the year preceding the follow-up examination (90% vs. 50%, age-adjusted P = 0.02) and had current back pain (65% vs. 21%, age-adjusted P = 0.03). Women with a new vertebral fracture at the 12-year follow-up examination had a higher subsequent mortality rate in the next 10 years [age-adjusted hazard ratio 2.8 (95% CI 1.0–7.9)] as compared with women without. The mortality rate during the 22 years following the diagnosis among the male patients was 111.7 per 1,000 person-years as compared with 73.4 per 1,000 person-years among the male population at risk. The mortality rate among the female patients was 95.1 per 1,000 person-years as compared with 62.0 per 1,000 person-years among the female population at risk. We conclude that a clinically diagnosed thoracic or lumbar vertebral fracture in the elderly can be regarded as a risk factor for subsequent, long-term morbidity, especially in women, and for mortality in both genders.

Keywords

Fracture Morbidity Mortality Osteoporosis Vertebra 

References

  1. 1.
    Chrischilles, EA, Butler, CD, Davis, CS, Wallace, RB 1991A model of lifetime osteoporosis impactArch Intern Med15120262032PubMedGoogle Scholar
  2. 2.
    Bengner, U, Johnell, O, Redlund-Johnell, I 1988Changes in incidence and prevalence of vertebral fractures during 30 yearsCalcif Tissue Int42293296PubMedGoogle Scholar
  3. 3.
    Kanis, JA, Johnell, O, Oden, A, Sembo, I, Redlund-Johnell, I, Dawson, A, Laet, C, Jonsson, B 2000Long-term risk of osteoporotic fracture in MalmöOsteoporos Int11669674PubMedGoogle Scholar
  4. 4.
    Cooper, C, Atkinson, EJ, Jacobsen, SJ, O’Fallon, WM, Melton, LJ,3rd 1993Population-based study of survival after osteoporotic fracturesAm J Epidemiol13710011005PubMedGoogle Scholar
  5. 5.
    Center, JR, Nguyen, TV, Schneider, D, Sambrook, PN, Eisman, JA 1999Mortality after all major types of osteoporotic fracture in men and women: an observational studyLancet353878882PubMedGoogle Scholar
  6. 6.
    Cauley, JA, Thompson, DE, Ensrud, KC, Scott, JC, Black, D 2000Risk of mortality following clinical fracturesOsteoporos Int11556561PubMedGoogle Scholar
  7. 7.
    Zethraeus N BF, Johnell O, Kanis J, Önnby K, Jönsson B (2002) Costs and quality of life associated with osteoporosis related fractures—results from a Swedish survey. SSE/EFI Working Paper Series in Economics and Finance, at the Stockholm School of Economics, Working paper No. 512Google Scholar
  8. 8.
    Ettinger, B, Black, DM, Nevitt, MC, Rundle, AC, Cauley, JA, Cummings, SR, Genant, HK 1992Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research GroupJ Bone Miner Res7449456PubMedGoogle Scholar
  9. 9.
    Leidig, G, Minne, HW, Sauer, P, Wuster, C, Wuster, J, Lojen, M, Raue, F, Ziegler, R 1990A study of complaints and their relation to vertebral destruction in patients with osteoporosisBone Miner8217229PubMedGoogle Scholar
  10. 10.
    Lyles, KW, Gold, DT, Shipp, KM, Pieper, CF, Martinez, S, Mulhausen, PL 1993Association of osteoporotic vertebral compression fractures with impaired functional statusAm J Med94595601PubMedGoogle Scholar
  11. 11.
    Nevitt, MC, Ettinger, B, Black, DM, Stone, K, Jamal, SA, Ensrud, K, Segal, M, Genant, HK, Cummings, SR 1998The association of radiographically detected vertebral fractures with back pain and function: a prospective studyAnn Intern Med128793800PubMedGoogle Scholar
  12. 12.
    Silverman, SL, Minshall, ME, Shen, W, Harper, KD, Xie, S 2001The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation StudyArthritis Rheum4426112619PubMedGoogle Scholar
  13. 13.
    Cooper, C, Atkinson, EJ, O’Fallon, WM, Melton, LJ,3rd 1992Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989J Bone Miner Res7221227PubMedGoogle Scholar
  14. 14.
    Black, DM, Arden, NK, Palermo, L, Pearson, J, Cummings, SR 1999Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research GroupJ Bone Miner Res14821828PubMedGoogle Scholar
  15. 15.
    Ross, PD, Davis, JW, Epstein, RS, Wasnich, RD 1991Pre-existing fractures and bone mass predict vertebral fracture incidence in womenAnn Intern Med114919923PubMedGoogle Scholar
  16. 16.
    Lindsay, R, Silverman, SL, Cooper, C, Hanley, DA, Barton, I, Broy, SB, Licata, A, Benhamou, L, Geusens, P, Flowers, K, Stracke, H, Seeman, E 2001Risk of new vertebral fracture in the year following a fractureJAMA285320323PubMedGoogle Scholar
  17. 17.
    Gunnes, M, Mellstrom, D, Johnell, O 1998How well can a previous fracture indicate a new fracture? A questionnaire study of 29,802 postmenopausal womenActa Orthop Scand69508512PubMedGoogle Scholar
  18. 18.
    Melton, LJ,3rd, Atkinson, EJ, Cooper, C, O’Fallon, WM, Riggs, BL 1999Vertebral fractures predict subsequent fracturesOsteoporos Int10214221PubMedGoogle Scholar
  19. 19.
    Fujiwara, S, Kasagi, F, Yamada, M, Kodama, K 1997Risk factors for hip fracture in a Japanese cohortJ Bone Miner Res129981004PubMedGoogle Scholar
  20. 20.
    Kotowicz, MA, Melton, LJ,3rd, Cooper, C, Atkinson, EJ, O’Fallon, WM, Riggs, BL 1994Risk of hip fracture in women with vertebral fractureJ Bone Miner Res9599605PubMedGoogle Scholar
  21. 21.
    Cummings, SR, Nevitt, MC, Browner, WS, Stone, K, Fox, KM, Ensrud, KE, Cauley, J, Black, D, Vogt, TM 1995Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research GroupN Engl J Med332767773CrossRefPubMedGoogle Scholar
  22. 22.
    Johnell, O, Oden, A, Caulin, F, Kanis, JA 2001Acute and long-term increase in fracture risk after hospitalization for vertebral fractureOsteoporos Int12207214PubMedGoogle Scholar
  23. 23.
    Orwoll, E, Ettinger, M, Weiss, S, Miller, P, Kendler, D, Graham, J, Adami, S, Weber, K, Lorenc, R, Pietschmann, P, Vandormael, K, Lombardi, A 2000Alendronate for the treatment of osteoporosis in menN Engl J Med343604610PubMedGoogle Scholar
  24. 24.
    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, S A, Reiss, TF, Ensrud, KE 1996Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research GroupLancet34815351541PubMedGoogle Scholar
  25. 25.
    Lufkin, EG, Wahner, HW, O’Fallon, WM, Hodgson, SF, Kotowicz, MA, Lane, AW, Judd, HL, Caplan, RH, Riggs, BL 1992Treatment of postmenopausal osteoporosis with transdermal estrogenAnn Intern Med11719PubMedGoogle Scholar
  26. 26.
    Ettinger, B, Black, DM, Mitlak, BH, Knickerbocker, RK, Nickelsen, T, Genant, HK, Christiansen, C, Delmas, PD, Zanchetta, JR, Stakkestad, J, Gluer, CC, Kraeger, K, Cohen, FJ, Eckert, S, Ensrud, KE, Avioli, LV, Lips, P, Cummings, SR 1999Reduction 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) InvestigatorsJAMA282637645CrossRefPubMedGoogle Scholar
  27. 27.
    Chesnut, CH,3rd, Silverman, S, Andriano, K, Genant, H, Gimona, A, Harris, S, Kiel, D, LeBoff, M, Maricic, M, Miller, P, Moniz, C, Peacock, M, Richardson, P, Watts, N, Baylink, D 2000A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of Osteoporotic fractures study. PROOF Study GroupAm J Med109267276PubMedGoogle Scholar
  28. 28.
    Harris, ST, Watts, NB, Genant, HK, McKeever, CD, Hangartner, T, Keller, M, Chesnut, CH,3rd, Brown, J, Eriksen, EF, Hoseyni, MS, Axelrod, DW, Miller, PD 1999Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study GroupJAMA28213441352PubMedGoogle Scholar
  29. 29.
    Reginster, J, Minne, HW, Sorensen, OH, Hooper, M, Roux, C, Berandi, ML, Lund, B, Ethgen, D, Pack, S, Roumagnac, I, Eastell, R 2000Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study GroupOsteoporos Int118391PubMedGoogle Scholar
  30. 30.
    Hasserius, R, Redlund-Johnell, I, Mellstrom, D, Johansson, C, Nilsson, BE, Johnell, O 2001Vertebral deformation in urban Swedish men and women: prevalence based on 797 subjectsActa Orthop Scand72273278PubMedGoogle Scholar
  31. 31.
    O’Neill, TW, Cooper, C, Cannata, JB, Diaz Lopez, JB, Hoszowski, K, Johnell, O, Lorenc, RS, Nilsson, B, Raspe, H, Stewart, O,  et al. 1994Reproducibility of a questionnaire on risk factors for osteoporosis in a multicentre prevalence survey: the European Vertebral Osteoporosis StudyInt J Epidemiol23559565PubMedGoogle Scholar
  32. 32.
    ICD-10. Classification of diseases and health problems 1997. Swedish version of ICD-10. Stockholm, Sweden: The National Swedish Board of Health and Welfare, 1997Google Scholar
  33. 33.
    ICD-9. Classification of diseases 1987. Swedish version of ICD-9. Stockholm, Sweden: The National Swedish Board of Health and Welfare, 1987Google Scholar
  34. 34.
    Melton, LJ,3rd, Lane, AW, Cooper, C, Eastell, R, O’Fallon, WM, Riggs, BL 1993Prevalence and incidence of vertebral deformitiesOsteoporos Int3113119PubMedGoogle Scholar
  35. 35.
    Weber, K, Lunt, M, Gowin, W, Lauermann, T, Armbrecht, G, Wieland, E, Leb, G, O’Neill, T, Felsenberg, D, Reeve, J 1999Measurement imprecision in vertebral morphometry of spinal radiographs obtained in the European Prospective Osteoporosis Study: consequences for the identification of prevalent and incident deformitiesBr J Radiol72957966PubMedGoogle Scholar
  36. 36.
    Scane, AC, Francis, RM, Sutcliflte, AM, Francis, MJ, Rawlings, DJ, Chappie, CL 1999Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in menOsteoporos Int99197PubMedGoogle Scholar
  37. 37.
    Ross, PD, Ettinger, B, Davis, JW, Melton, LJ,3rd, Wasnich, RD 1991Evaluation of adverse health outcomes associated with vertebral fracturesOsteoporos Int1134140PubMedGoogle Scholar
  38. 38.
    Huang, C, Ross, PD, Wasnich, RD 1996Vertebral fracture and other predictors of physical impairment and health care utilizationArch Intern Med15624692475PubMedGoogle Scholar
  39. 39.
    Matthis, C, Weber, U, O’Neill, TW, Raspe, H 1998Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS)Osteoporos Int8364372PubMedGoogle Scholar
  40. 40.
    Ismail, AA, O’Neill, TW, Cooper, C, Finn, JD, Bhalla, AK, Cannata, JB, Delmas, P, Falch, JA, Felsch, B, Hoszowski, K, Johnell, O, Diaz-Lopez, JB, Lopez Vaz, A, Marchand, F, Raspe, H, Reid, DM, Todd, C, Weber, K, Woolf, A, Reeve, J, Silman, AJ 1998Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS)Osteoporos Int8291297PubMedGoogle Scholar
  41. 41.
    Kado, DM, Browner, WS, Palermo, L, Nevitt, MC, Genant, HK, Cummings, SR 1999Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research GroupArch Intern Med15912151220PubMedGoogle Scholar
  42. 42.
    Ensrud, KE, Thompson, DE, Cauley, JA, Nevitt, MC, Kado, DM, Hochberg, MC, Santora, AC,2nd, Black, DM 2000Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research GroupJ Am Geriatr Soc48241249PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • R. Hasserius
    • 1
  • M.K. Karlsson
    • 1
  • B. Jónsson
    • 1
  • I. Redlund-Johnell
    • 1
  • O. Johnell
    • 1
  1. 1.Departments of Orthopaedics and Departments of Diagnostic RadiologyMalmö University Hospital, Lund UniversityMalmöSweden

Personalised recommendations