Skip to main content

Worldwide prevalence and incidence of osteoporotic vertebral fractures

Osteoporosis International volume 28, pages 1531–1542 (2017)Cite this article

Abstract

We investigated the prevalence and incidence of vertebral fractures worldwide. We used a systematic Medline search current to 2015 and updated as per authors’ libraries. A total of 62 articles of fair to good quality and comparable methods for vertebral fracture identification were considered. The prevalence of morphometric vertebral fractures in European women is highest in Scandinavia (26%) and lowest in Eastern Europe (18%). Prevalence rates in North America (NA) for White women ≥50 are 20–24%, with a White/Black ratio of 1.6. Rates in women ≥50 years in Latin America are overall lower than Europe and NA (11–19%). In Asia, rates in women above ≥65 are highest in Japan (24%), lowest in Indonesia (9%), and in the Middle East, Lebanon, rates are 20%. The highest–lowest ratio between countries, within and across continents, varied from 1.4–2.6. Incidence data is less abundant and more heterogeneous. Age-standardized rates in studies combining hospitalized and ambulatory vertebral fractures are highest in South Korea, USA, and Hong Kong and lowest in the UK. Neither a North-South gradient nor a relation to urbanization is evident. Conversely, the incidence of hospitalized vertebral fractures in European patients ≥50 shows a North-South gradient with 3–3.7-fold variability. In the USA, rates in Whites are approximately 4-fold higher than in Blacks. Vertebral fractures variation worldwide is lower than observed with hip fractures, and some of highest rates are unexpectedly from Asia. Better quality representative studies are needed. We investigate the occurrence of vertebral fractures, worldwide, using published data current until the present. Worldwide, the variation in vertebral fractures is lower than observed for hip fractures. Some of the highest rates are from North America and unexpectedly Asia. The highest–lowest ratio between countries, within and across continents, varied from 1.4–2.6. Better quality representative data is needed.

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

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Bouxsein M, Genant H (2010) International Osteoporosis Foundation Vertebral Fracture Audit. wwwiofbonehealthorg

  2. Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int

  3. Fink HA, Milavetz DL, Palermo L et al (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20(7):1216–1222

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJΙ (1991) Classification of vertebral fractures. J Bone Miner Res 6(3):207–215

    Article  CAS  PubMed  Google Scholar 

  6. O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: the European vertebral osteoporosis study. J Bone Miner Res 11(7):1010–1018

    Article  PubMed  Google Scholar 

  7. Cauley JA, El-Hajj Fuleihan G, Luckey MM (2011) FRAX(R) international task force of the 2010 joint International Society for Clinical Densitometry & international osteoporosis foundation position development conference. J Clin Densitom 14(3):237–239

    Article  PubMed  Google Scholar 

  8. Melton LJ, Kan SH, Frye KM, Wahner HW, O’Fallon WM, Riggs B (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011

    Article  PubMed  Google Scholar 

  9. 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):883–892

    Article  CAS  PubMed  Google Scholar 

  10. Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian multicenter osteoporosis study (CaMos). Osteoporos Int 11(8):680–687

    Article  CAS  PubMed  Google Scholar 

  11. 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 3:138–147

    Article  CAS  PubMed  Google Scholar 

  12. Davies KM, Recker RR, Heaney RP (1989) Normal vertebral dimensions and normal variation in serial measurements of vertebrae. J Bone Miner Res 4(3):341–349

    Article  CAS  PubMed  Google Scholar 

  13. Genant HK, Wu CY, Kuijk CV, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148

    Article  CAS  PubMed  Google Scholar 

  14. Ling X, Cummings SR, Mingwei Q et al (2000) Vertebral fractures in Beijing, China: the Beijing osteoporosis project. J Bone Miner Res 15(10):2019–2025

    Article  CAS  PubMed  Google Scholar 

  15. 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):1215–1220

    Article  CAS  PubMed  Google Scholar 

  16. Melton LJ 3rd, Lane AW, Cooper C, Eastell R, O’Fallon WM, Riggs BL (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3(3):113–119

    Article  PubMed  Google Scholar 

  17. Cauley JA, Palermo L, Vogt M et al (2008) Prevalent vertebral fractures in black women and white women. J Bone Miner Res 23(9):1458–1467

    Article  PubMed  PubMed Central  Google Scholar 

  18. Clark P, Cons-Molina F, Deleze M et al (2009) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American vertebral osteoporosis study (LAVOS). Osteoporos Int 20(2):275–282

    Article  CAS  PubMed  Google Scholar 

  19. Clark P, Cons-Molina F, Deleze M, Talavera JO, Palermo L, Cummings SO (2010) The prevalence of radiographic vertebral fractures in Mexican men. Osteoporos Int 21(9):1523–1528

    Article  CAS  PubMed  Google Scholar 

  20. Ho-Pham LT, Mai LD, Pham HN, Nguyen ND, Nguyen TV (2012) Reference ranges for vertebral heights and prevalence of asymptomatic (undiagnosed) vertebral fracture in Vietnamese men and women. Arch Osteoporos 7:257–266

    Article  PubMed  Google Scholar 

  21. Kwok AW, Leung JC, Chan AY et al (2012) Prevalence of vertebral fracture in Asian men and women: comparison between Hong Kong, Thailand, Indonesia and Japan. Public Health 126(6):523–531

    Article  CAS  PubMed  Google Scholar 

  22. Lau EM, Chan HH, Woo J et al (1996) Normal ranges for vertebral height ratios and prevalence of vertebral fracture in Hong Kong Chinese: a comparison with American Caucasians. J Bone Miner Res 11(9):1364–1368

    Article  CAS  PubMed  Google Scholar 

  23. Tsang SW, Bow CH, Chu EY, Yeung SC, Soong CC, Kung AW (2011) Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture. Osteoporos Int 22(2):667–674

    Article  CAS  PubMed  Google Scholar 

  24. Jitapunkul S, Thamarpirat J, Chaiwanichsiri D, Boonhong J (2008) Incidence of vertebral fractures in Thai women and men: a prospective population-based study. Geriatr Gerontol Int 8(4):251–258

    Article  PubMed  Google Scholar 

  25. Tsai K, Twu S, Chieng P, Yang R, Lee T (1996) Prevalence of vertebral fractures in chinese men and women in urban Taiwanese communities. Calcif Tissue Int 59(4):249–253

    Article  CAS  PubMed  Google Scholar 

  26. Shin CS, Kim MJ, Shim SM et al (2012) The prevalence and risk factors of vertebral fractures in Korea. J Bone Miner Metab 30(2):183–192

    Article  PubMed  Google Scholar 

  27. Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA (2002) The incidence of vertebral fractures in men and women: the Rotterdam study. J Bone Miner Res 17(6):1051–1056

    Article  PubMed  Google Scholar 

  28. Spector TD, McCloskey EV, Doyle DV, Kanis JA (1993) Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford study. J Bone Miner Res 8(7):817–822

    Article  CAS  PubMed  Google Scholar 

  29. Ballane G, Cauley JA, Arabi A, El-Hajj Fuleihan G (2013) Geographic variability in hip and vertebral fractures. In: Marcus R, Feldman D, Dempster DW, Luckey M, Cauley CE (eds) Osteoporosis, 4th edn, pp 623–644

    Chapter  Google Scholar 

  30. Grados F, Marcelli C, Dargent-Molina P et al (2004) Prevalence of vertebral fractures in French women older than 75 years from the EPIDOS study. Bone 34(2):362–367

    Article  CAS  PubMed  Google Scholar 

  31. Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15(8):1564–1572

    Article  CAS  PubMed  Google Scholar 

  32. Waterloo S, Nguyen T, Ahmed LA et al (2012) Important risk factors and attributable risk of vertebral fractures in the population-based Tromso study. BMC Musculoskelet Disord 13:163

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sanfelix-Genoves J, Reig-Molla B, Sanfelix-Gimeno G et al (2010) The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study). Bone 47(3):610–616

    Article  PubMed  Google Scholar 

  34. Vokes TJ, Gillen DL, Pham AT, Lovett JM (2007) Risk factors for prevalent vertebral fractures in black and white female densitometry patients. J Clin Densitom 10(1):1–9

    Article  PubMed  Google Scholar 

  35. Yakemchuk V, Beaumont LF, Webber CE, Gulenchyn KY, Jager PL (2012) Vertebral fracture prevalence in a referral population of 750 Canadian men and women. Clin Radiol 67(11):1061–1068

    Article  CAS  PubMed  Google Scholar 

  36. Lopes JB, Danilevicius CF, Takayama L et al (2011) Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly. Osteoporos Int 22(2):711–719

    Article  CAS  PubMed  Google Scholar 

  37. Kwok AW, Gong JS, Wang YX et al (2013) Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 24(3):877–885

    Article  CAS  Google Scholar 

  38. Ho-Pham LT, Nguyen ND, Vu BQ, Pham HN, Nguyen TV (2009) Prevalence and risk factors of radiographic vertebral fracture in postmenopausal Vietnamese women. Bone 45(2):213–217

    Article  PubMed  Google Scholar 

  39. Marwaha RK, Tandon N, Gupta Y et al (2012) The prevalence of and risk factors for radiographic vertebral fractures in older Indian women and men: Delhi vertebral osteoporosis study (DeVOS). Arch Osteoporos 7:201–207

    Article  PubMed  Google Scholar 

  40. Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G, Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18(8):1547–1553

    Article  PubMed  Google Scholar 

  41. Kitazawa A, Kushida K, Yamazaki K, Inoue T (2001) Prevalence of vertebral fractures in a population-based sample in Japan. J Bone Miner Metab 19(2):115–118

    Article  CAS  PubMed  Google Scholar 

  42. Rostom S, Allali F, Bennani L, Abouqal R, Hajjaj-Hassouni N (2012) The prevalence of vertebral fractures and health-related quality of life in postmenopausal women. Rheumatol Int 32(4):971–980

    Article  CAS  PubMed  Google Scholar 

  43. El Maghraoui A, Mounach A, Rezqi A, Achemlal L, Bezza A, Ghozlani I (2012) Vertebral fracture assessment in asymptomatic men and its impact on management. Bone 50(4):853–857

    Article  CAS  PubMed  Google Scholar 

  44. Baddoura R, Arabi A, Haddad-Zebouni S et al (2007) Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis. Bone 40(4):1066–1072

    Article  PubMed  Google Scholar 

  45. Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674

    Article  CAS  PubMed  Google Scholar 

  46. Sanders KM, Seeman E, Ugoni AM et al (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10(3):240–247

    Article  CAS  PubMed  Google Scholar 

  47. Oinuma T, Sakuma M, Endo N (2010) Secular change of the incidence of four fracture types associated with senile osteoporosis in Sado, Japan: the results of a 3-year survey. J Bone Miner Metab 28(1):55–59

    Article  PubMed  Google Scholar 

  48. Bow CH, Cheung E, Cheung CL et al (2012) Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 23(3):879–885

    Article  CAS  PubMed  Google Scholar 

  49. van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29(6):517–522

    Article  PubMed  Google Scholar 

  50. Bassgen K, Westphal T, Haar P, Kundt G, Mittlmeier T, Schober HC (2013) Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200,413 inhabitants. Journal of public health 35(2):255–261

    Article  PubMed  Google Scholar 

  51. Piscitelli P, Tarantino U, Chitano G et al (2011) Updated incidence rates of fragility fractures in Italy: extension study 2002-2008. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases 8(3):54–61

    Google Scholar 

  52. Lippuner K, Johansson H, Kanis JA, Rizzoli R (2009) Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 20(7):1131–1140

    Article  CAS  PubMed  Google Scholar 

  53. Siggeirsdottir K, Aspelund T, Jonsson BY et al Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989-2008. Osteoporos Int:2013

  54. Dzajkovska B, Wertheimer AI, Mrhar A (2007) The burden-of-illness study on osteoporosis in the Slovenian female population. Pharm World Sci 29(4):404–411

    Article  PubMed  Google Scholar 

  55. Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21(4):492–499

    Article  CAS  Google Scholar 

  56. Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37

    Article  PubMed  Google Scholar 

  57. Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ 3rd (2013) Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res

  58. Lee YK, Jang S, Jang S et al (2012) Mortality after vertebral fracture in Korea: analysis of the National Claim Registry. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 23(7):1859–1865

    Article  Google Scholar 

  59. Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of national register sources. Osteoporos Int 7(2):138–144

    Article  CAS  PubMed  Google Scholar 

  60. Jansson KA, Blomqvist P, Svedmark P et al (2010) Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital. Eur J Epidemiol 25(6):431–437

    Article  PubMed  PubMed Central  Google Scholar 

  61. Bouza C, Lopez T, Palma M, Amate JM (2007) Hospitalised osteoporotic vertebral fractures in Spain: analysis of the national hospital discharge registry. Osteoporos Int 18(5):649–657

    Article  CAS  PubMed  Google Scholar 

  62. Jacobsen SJ, Cooper C, Gottlieb MS, Goldberg J, Yahnke DP, Melton LJ 3rd (1992) Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989. Epidemiology 3(6):515–518

    Article  CAS  PubMed  Google Scholar 

  63. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    Article  PubMed  Google Scholar 

  64. Cooper C, Cole ZA, Holroyd CR et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Parisien M, Cosman F, Morgan D et al (1997) Histomorphometric assessment of bone mass, structure, and remodeling: a comparison between healthy black and white premenopausal women. J Bone Miner Res Off J Am Soc Bone Miner Res 12(6):948–957

    Article  CAS  Google Scholar 

  66. Qiu S, Rao DS, Palnitkar S, Parfitt AM (2006) Differences in osteocyte and lacunar density between black and white American women. Bone 38(1):130–135

    Article  PubMed  Google Scholar 

  67. Schousboe JT (2015) Epidemiology of Vertebral Fractures. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry

  68. Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10(6):338–351

    Article  PubMed  Google Scholar 

  69. Cooper C, Atkinson EJ, Kotowicz M, O’Fallon WM, Melton LJ 3rd (1992) Secular trends in the incidence of postmenopausal vertebral fractures. Calcif Tissue Int 51(2):100–104

    Article  CAS  PubMed  Google Scholar 

  70. Leslie WD, Sadatsafavi M, Lix LM et al (2011) Secular decreases in fracture rates 1986-2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22(7):2137–2143

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Special thanks to Ms. Aida Farha, Medical Information Specialist, Saab Medical Library, American University of Beirut, for her advice and assistance in designing comprehensive and complex searches of the various medical literature resources, and provision of selected articles. The authors also thank Mr. Ali Hammoudi for his help with the tables and figures.

Author information

Authors and Affiliations

  1. Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Bliss Street, Beirut, 113-6044, Lebanon

    G. Ballane & G. El-Hajj Fuleihan

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    J. A. Cauley

  3. Barnabas Health Osteoporosis Center, Livingston, NJ, USA

    M. M. Luckey

Authors
  1. G. Ballane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. A. Cauley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. M. Luckey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. El-Hajj Fuleihan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. El-Hajj Fuleihan.

Ethics declarations

Conflicts of interest

None.

Electronic supplementary material

ESM 1

(DOCX 32 kb)

ESM 2

(DOCX 61 kb)

ESM 3

(DOCX 45 kb)

Appendix 4

Fig. Age-specific incidence rates for vertebral fractures in men and women worldwide. (JPEG 608 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ballane, G., Cauley, J.A., Luckey, M.M. et al. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28, 1531–1542 (2017). https://doi.org/10.1007/s00198-017-3909-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-3909-3

Keywords

  • Ethnicities
  • Incidence
  • Prevalence
  • Variation
  • Vertebral fractures
  • Worldwide