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Osteoporosis identification among previously undiagnosed individuals with vertebral fractures

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Abstract

Summary

Because osteoporosis is under-recognized in patients with vertebral fractures, we evaluated characteristics associated with osteoporosis identification. Most patients with vertebral fractures did not receive evaluation or treatment for osteoporosis. Black, younger, and male participants were particularly unlikely to have had recognized osteoporosis, which could increase their risk of negative outcomes.

Introduction

Vertebral fractures may be identified on imaging but fail to prompt evaluation for osteoporosis. Our objective was to evaluate characteristics associated with clinical osteoporosis recognition in patients who had vertebral fractures detected on their thoracolumbar spine imaging reports.

Methods

We prospectively identified individuals who received imaging of the lower spine at primary care clinics in 4 large healthcare systems who were eligible for osteoporosis screening and lacked indications of osteoporosis diagnoses or treatments in the prior year. We evaluated characteristics of participants with identified vertebral fractures that were associated with recognition of osteoporosis (diagnosis code in the health record; receipt of bone mineral density scans; and/or prescriptions for anti-osteoporotic medications). We used mixed models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs).

Results

A total of 114,005 participants (47% female; mean age 65 (interquartile range: 57–72) years) were evaluated. Of the 8579 (7%) participants with vertebral fractures identified, 3784 (44%) had recognition of osteoporosis within the subsequent year. In adjusted regressions, Black participants (OR (95% CI): 0.74 (0.57, 0.97)), younger participants (age 50–60: 0.48 (0.42, 0.54); age 61–64: 0.70 (0.60, 0.81)), and males (0.39 (0.35, 0.43)) were less likely to have recognized osteoporosis compared to white participants, adults aged 65 + years, or females.

Conclusion

Individuals with identified vertebral fractures commonly did not have recognition of osteoporosis within a year, particularly those who were younger, Black, or male. Providers and healthcare systems should consider efforts to improve evaluation of osteoporosis in patients with vertebral fractures.

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Funding

This work was supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreements UH2AT007766 and UH3AR066795 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Research was supported by investigators at the University of Washington Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Conditions Resource Cores. NIAMS/NIH P30AR072572; the project used the CLEAR Center Resource and Methodologic Cores. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, University of Washington, 4333 Brooklyn Ave NE Box 359558, Seattle, WA, 98195-9558, USA

    L. S. Gold, R. F. Cody Jr., K. T. James, D. R. Haynor & J. G. Jarvik

  2. Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA

    L. S. Gold, W. K. Tan, K. T. James, P. Suri, J. L. Friedly, P. J. Heagerty, S. D. Rundell & J. G. Jarvik

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    W. K. Tan, E. N. Meier & P. J. Heagerty

  4. Flatiron Health, Inc, New York, NY, USA

    W. K. Tan

  5. Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA

    Z. A. Marcum

  6. Kaiser Permanente Washington, Seattle, WA, USA

    K. J. Sherman

  7. Department of Radiology, Henry Ford Hospital, Detroit, MI, USA

    B. Griffith

  8. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    A. L. Avins

  9. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    D. F. Kallmes & P. H. Luetmer

  10. Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA

    P. Suri

  11. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA

    J. L. Friedly & S. D. Rundell

  12. Departments of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, OR, USA

    R. A. Deyo

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  1. L. S. Gold
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Corresponding author

Correspondence to L. S. Gold.

Ethics declarations

Ethics approval

All participating institutional review boards determined that the study was minimal risk and granted waivers of both consent and Health Insurance Portability and Accountability Act authorization. All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional committees and with the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

David F. Kallmes discloses that he has ownership/stock in Kypheze, LLC; patents involved in spine augmentation; and has received research support and royalties from Medtronic. Laura S. Gold, Richard F. Cody, Jr., W. Katherine Tan, Zachary A. Marcum, Eric N. Meier, Karen J. Sherman, Kathryn T. James, Brent Griffith, Andrew L. Avins, Pradeep Suri, Janna L. Friedly, Patrick J. Heagerty, Richard A. Deyo, Patrick H. Luetmer, Sean D. Rundell, David R. Haynor, and Jeffrey G. Jarvik do not have financial or non-financial interests that are directly or indirectly related to this work.

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Gold, L.S., Cody, R.F., Tan, W.K. et al. Osteoporosis identification among previously undiagnosed individuals with vertebral fractures. Osteoporos Int 33, 1925–1935 (2022). https://doi.org/10.1007/s00198-022-06450-7

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