Skip to main content

Severity of vertebral fracture and risk of hip fracture: a nested case–control study



Severe vertebral fractures strongly predicted subsequent hip fracture in this population-based study. Such high-risk patients should be provided with clinical evaluation and care for osteoporosis.


Vertebral fractures are commonly osteoporotic and known to predict hip fracture. The aim of this study was to evaluate associations between the severity of vertebral fractures and the risk of subsequent hip fracture.


Chest radiographs were obtained of 7,095 Finnish men and women aged 30 years or over in the Mini-Finland Health Survey in 1978–1980. Record linkage to the National Hospital Discharge Register identified 182 subjects from the survey who had subsequently been hospitalized for primary treatment of hip fracture by the end of 1994. A nested case–control setting was adopted, where three controls individually matched for age, gender, and place of residence were drawn for 169 subjects with hip fracture from the same cohort. Baseline vertebral fractures were identified at levels T3 to T12, and their morphology was categorized to mild, moderate, or severe according to Genant's classification.


Severe vertebral fracture (>40% reduction in vertebral body height) strongly predicted hip fracture. After controlling for education, physical activity, smoking, alcohol consumption, and self-rated general health, the adjusted relative odds was 12.06 (95% confidence interval, 3.80–38.26). Mild to moderate fracture grades and the number of compressed vertebral bodies showed no prediction for hip fracture.


The presence of a severe vertebral fracture in the thoracic spine strongly predicts subsequent hip fracture. Such high-risk patients should be clinically evaluated and provided with care for osteoporosis and measures to reduce the risk of falling as required.

This is a preview of subscription content, access via your institution.


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

    Article  PubMed  Google Scholar 

  2. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJIII (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota 1985-1989. J Bone Miner Res 7:221–227

    CAS  Article  PubMed  Google Scholar 

  3. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    CAS  Article  PubMed  Google Scholar 

  4. Haentjens P, Autier P, Collins J, Velkeniers B, Vanderschueren D, Boonen S (2003) Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women, a meta-analysis. J Bone Joint Surg 10:1936–1943

    Google Scholar 

  5. Hasserius R, Johnell O, Nilsson BE et al (2003) Hip fracture patients have more vertebral deformities than subjects in population-based studies. Bone 32:180–184

    CAS  Article  PubMed  Google Scholar 

  6. Schousboe JT, Howard AF, Li-Yung L, Taylor BC, Ensur KE (2006) Association between prior non-spine non-hip fractures or prevalent radiographic vertebral deformities known to be at least 10 years old and incident hip fracture. J Bone Miner Res 21:1557–1564

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Aromaa A, Heliövaara M, Impivaara O et al (1989) Health, functional limitations and need for care in Finland. Basic results from the Mini-Finland Health Survey. Publications of the Social Insurance Institution AL32, Helsinki, in Finnish with English Summary

    Google Scholar 

  9. Martikainen P, Aromaa A, Heliövaara M et al (1999) Reliability of perceived health by sex and age. Sos Sci and Med 48:1117–1122

    CAS  Article  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  11. Puisto V, Rissanen H, Heliövaara M, Knekt P, Helenius I (2008) Mortality in the presence of a vertebral fracture, scoliosis, or Scheuermann’s disease in the thoracic spine. Ann Epidemiology 18:595–601

    Article  Google Scholar 

  12. Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Ostoporos Int 11:577–582

    CAS  Article  Google Scholar 

  13. Sund R, Nurmi-Lüthe I, Lüthe P, Tanninen S, Narinen A, Keskimäki I (2007) Comparing properties of audit data and routinely collected register data in case of performance assessment of hip fracture treatment in Finland. Methods Inf Med 46:558–566

    CAS  PubMed  Google Scholar 

  14. Keskimäki I, Aro S (1991) Accuracy of data on diagnosis, procedures and accidents in the Finnish Hospital Discharge Register. Int J Health Sci 2:15–21

    Google Scholar 

  15. Gallacher SJ, Gallagher AP, McQuillian C, Mithchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–192

    CAS  Article  PubMed  Google Scholar 

  16. El Maghraoui A, Mounach A, Gassim S, Ghazi M (2008) Vertebral fracture assessment in healthy men: prevalence and risk factors. Bone 43:544–548

    CAS  Article  PubMed  Google Scholar 

  17. Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int Nov 15:887–896

    CAS  Article  Google Scholar 

  18. Ferrar L, Jiang G, Armbrecht G, Reid DM et al (2007) Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). Bone 41:5–12

    CAS  Article  PubMed  Google Scholar 

  19. Ferrar L, Jiang G, Cawthon PM et al (2007) Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 22:1434–1441

    Article  PubMed  Google Scholar 

  20. Cummings SR, Black DM, Nevitt MC et al (1990) Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA 263:665–668

    CAS  Article  PubMed  Google Scholar 

  21. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936, Review

    Article  PubMed  Google Scholar 

Download references


This study has been supported by the Finnish National Institute for Health and Welfare, Finnish Foundation for Paediatric Research, Finnish Orthopaedic Research foundation, Finnish Medical Foundation, Medronic International, and Baxter Finland.

Conflicts of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to V. Puisto.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Puisto, V., Heliövaara, M., Impivaara, O. et al. Severity of vertebral fracture and risk of hip fracture: a nested case–control study. Osteoporos Int 22, 63–68 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Epidemiological study
  • Fracture risk
  • Hip fracture
  • Osteoporosis
  • Vertebral fracture