Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study

Abstract

Vertebral fracture (VF) is a common osteoporotic fracture, while its epidemiology varies according to regions and ethnicities, little is known about it in Japan. Using whole-spine radiographs from a population-based cohort study, the Research on Osteoarthritis/Osteoporosis Against Disability study 3rd survey performed in 2012–2013, we estimated the sex- and age-specific prevalence of VF in the Japanese. Genant’s semiquantitative method (SQ) was used to define VF; SQ ≥ 1 as VF, SQ = 1 as mild VF, SQ≥ 2 as severe VF. We also revealed accurate site-specific prevalence, and associated factors with mild and severe VF. The participants were 506 men [mean age 66.3 years, standard deviation (SD):13.0] and 1038 women (mean age 65.3 years, SD: 12.6). The prevalence of VF in participants aged under 40, in their 40s, 50s, 60s, 70s, and ≥ 80 years was 17.4, 7.9, 18.5, 25.6, 26.3, and 41.5%, respectively, in men, and 2.9%, 2.4%, 7,3, 10.3, 27.1, and 53.0%, respectively, in women. Men had a significantly higher prevalence of mild VF (21.2%) than women (10.0%, p < 0.001); whereas, severe VF was significantly more prevalent in women (9.1%) than in men (4.7%, p = 0.003). VF was distributed with 2 peaks regarding site; one large peak at the thoracolumbar region, and another at the middle thoracic lesion. Low back pain and decreased walking ability were independently associated with severe VF, but not with mild VF, after adjustment for participant characteristics. Decreased walking ability was associated with multiple VFs in women, but not in men.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Riggs BL, Melton Lii LJ (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511S

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Suzuki N, Ogikubo O, Hansson T (2009) The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation. Eur Spine J 18:77–88. https://doi.org/10.1007/s00586-008-0847-y

    Article  PubMed  Google Scholar 

  3. 3.

    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392. https://doi.org/10.1359/jbmr.2000.15.7.1384 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119. https://doi.org/10.1007/s00198-003-1547-4

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Pluijm SMTA, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572. https://doi.org/10.1359/jbmr.2000.15.8.1564

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42. https://doi.org/10.1007/s00198-003-1490-4

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Edidin AA, Ong KL, Lau E, Kurtz SM (2015) Morbidity and mortality after vertebral fractures: comparison of vertebral augmentation and nonoperative management in the medicare population. Spine 40:1228–1241. https://doi.org/10.1097/brs.0000000000000992 (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  8. 8.

    Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227. https://doi.org/10.1002/jbmr.5650070214 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures (in eng). J Bone Miner Res 6:207–215. https://doi.org/10.1002/jbmr.5650060302

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Black DM, Palermo L, Nevitt MC, Genant HK, Epstein R, San Valentin R, Cummings SR (1995) Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Miner Res 10:890–902. https://doi.org/10.1002/jbmr.5650100610 (in eng)

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    O’Neill TWFD, 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 11:1010–1018. https://doi.org/10.1002/jbmr.5650110719

    Article  PubMed  Google Scholar 

  12. 12.

    Yoshimura N, Kinoshita H, Danjoh S, Yamada H, Tamaki T, Morioka S, Kasamatsu T, Hashimoto T, Inoue T (1995) Prevalence of vertebral fractures in a rural japanese population. J Epidemiol 5:171–175. https://doi.org/10.2188/jea.5.171

    Article  Google Scholar 

  13. 13.

    Kadowaki E, Tamaki J, Iki M, Sato Y, Chiba Y, Kajita E, Kagamimori S, Kagawa Y, Yoneshima H (2010) Prevalent vertebral deformity independently increases incident vertebral fracture risk in middle-aged and elderly Japanese women: the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 21:1513–1522. https://doi.org/10.1007/s00198-009-1113-9

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Kwok AW, Leung JC, Chan AY, Au BS, Lau EM, Yurianto H, Yuktanandana P, Yoshimura N, Muraki S, Oka H, Akune T, Leung PC (2012) Prevalence of vertebral fracture in Asian men and women: comparison between Hong Kong, Thailand, Indonesia and Japan. Public Health 126:523–531. https://doi.org/10.1016/j.puhe.2012.03.002

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Fujiwara S, Hamaya E, Goto W, Masunari N, Furukawa K, Fukunaga M, Nakamura T, Miyauchi A, Chen P (2011) Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk in Japan. Bone 49:520–525. https://doi.org/10.1016/j.bone.2011.05.021

    Article  PubMed  Google Scholar 

  16. 16.

    Nishimura A, Akeda K, Kato K, Asanuma K, Yamada T, Uchida A, Sudo A (2014) Osteoporosis, vertebral fractures and mortality in a Japanese rural community. Mod Rheumatol 24:840–843. https://doi.org/10.3109/14397595.2013.866921

    Article  PubMed  Google Scholar 

  17. 17.

    Lian J, Levine N, Cho W (2018) A review of lumbosacral transitional vertebrae and associated vertebral numeration. Eur Spine J 27:995–1004. https://doi.org/10.1007/s00586-018-5554-8

    Article  PubMed  Google Scholar 

  18. 18.

    O’Brien MF, Blanke KM, Lenke LG, Spinal Deformity Study Group (SDSG) (2008) Radiographic Measurement Manual. Medtronic Sofamor Danek USA Inc., Memphis

    Google Scholar 

  19. 19.

    Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M, Saika A, Yoshida H, Suzuki T, Yamamoto S, Ishibashi H, Kawaguchi H, Nakamura K, Akune T (2009) Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab 27:620–628. https://doi.org/10.1007/s00774-009-0080-8

    Article  PubMed  Google Scholar 

  20. 20.

    Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T (2010) Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. Int J Epidemiol 39:988–995. https://doi.org/10.1093/ije/dyp276

    Article  PubMed  Google Scholar 

  21. 21.

    Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K, Lewis C, Cawthon PM, Marcus R, Marshall LM, McGowan J, Phipps K, Sherman S, Stefanick ML, Stone K (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585. https://doi.org/10.1016/j.cct.2005.05.006

    Article  PubMed  Google Scholar 

  22. 22.

    Yoshimura N, Muraki S, Oka H, Tanaka S, Ogata T, Kawaguchi H, Akune T, Nakamura K (2015) Association between new indices in the locomotive syndrome risk test and decline in mobility: third survey of the ROAD study. J Orthop Sci 20:896–905. https://doi.org/10.1007/s00776-015-0741-5

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW et al (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15:95–101. https://doi.org/10.1016/j.jamda.2013.11.025

    Article  PubMed  Google Scholar 

  24. 24.

    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Densitometry TISFC (2015) 2015 ISCD Official Positions—Adult

  26. 26.

    Trone DW, Kritz-Silverstein D, von Muhlen DG, Wingard DL, Barrett-Connor E (2007) Is radiographic vertebral fracture a risk factor for mortality? Am J Epidemiol 166:1191–1197. https://doi.org/10.1093/aje/kwm206

    Article  PubMed  Google Scholar 

  27. 27.

    Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Menezes PR, Scazufca M, Kuroishi ME, Pereira RM (2011) Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly. Osteoporos Int 22:711–719. https://doi.org/10.1007/s00198-010-1258-6

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Kwok AW, Gong JS, Wang YX, Leung JC, Kwok T, Griffith JF, Leung PC (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. Osteoporos Int 24:877–885. https://doi.org/10.1007/s00198-012-2040-8

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellstrom D, Karlsson MK (2015) Low clinical relevance of a prevalent vertebral fracture in elderly men—the MrOs Sweden study. Spine J 15:281–289. https://doi.org/10.1016/j.spinee.2014.09.016

    Article  PubMed  Google Scholar 

  30. 30.

    Japanese Official Statistics MoIAaC (2015) Population Census 2015

  31. 31.

    Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606. https://doi.org/10.1097/brs.0b013e3181aad219 (in Eng, Phila Pa 1976)

    Article  PubMed  Google Scholar 

  32. 32.

    Kado DMBW, 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 159:1215–1220

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Mutikainen S, Rantanen T, Alen M, Kauppinen M, Karjalainen J, Kaprio J, Kujala UM (2011) Walking ability and all-cause mortality in older women. Int J Sports Med 32:216–222. https://doi.org/10.1055/s-0030-1268506

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001) Guideline for the prevention of falls in older persons. J Am Geriatr Soc 49:664–672 (in Eng)

    Article  Google Scholar 

  35. 35.

    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Cauley JA, Hochberg MC, Lui LY, Palermo L, Ensrud KE, Hillier TA, Nevitt MC, Cummings SR (2007) Long-term risk of incident vertebral fractures. JAMA 298:2761–2767. https://doi.org/10.1001/jama.298.23.2761 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770. https://doi.org/10.1007/s00198-006-0306-8

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501. https://doi.org/10.1210/edrv.22.4.0437 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Bischoff-Ferrari HA, Zhang Y, Kiel DP, Felson DT (2005) Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis. Arthritis Rheum 53:821–826. https://doi.org/10.1002/art.21601

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Rothenbacher D, Klenk J, Denkinger MD, Herbolsheimer F, Nikolaus T, Peter R, Boehm BO, Rapp K, Dallmeier D, Koenig W, Acti FESG (2014) Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects. Osteoporos Int 25:923–932. https://doi.org/10.1007/s00198-013-2565-5

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A (2013) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev: CD008618 https://doi.org/10.1002/14651858.cd008618.pub2

  42. 42.

    Szulc P, Munoz F, Marchand F, Delmas PD (2001) Semiquantitative evaluation of prevalent vertebral deformities in men and their relationship with osteoporosis: the MINOS study. Osteoporos Int 12:302–310. https://doi.org/10.1007/s001980170120 (in Eng)

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624. https://doi.org/10.1007/s00198-007-0413-1

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 20:1349–1355. https://doi.org/10.1359/JBMR.050317

    Article  PubMed  Google Scholar 

  45. 45.

    Ministry of Health, Labour and Welfare. The report of National Health and Nutrition Survey 2012. https://www.mhlw.go.jp/bunya/kenkou/eiyou/h24-houkoku.html. Accessed 12 Dec 2018

Download references

Acknowledgements

The authors wish to thank Dr. Naoki Hirabayashi of Kawakami Clinic, Hidakagawa Town; Mrs. Tomoko Takijiri, Mrs. Rie Takiguchi, Mrs. Kyoko Maeda, Ms. Ikuyo Ueyama, Mrs. Michiko Mori, Mrs. Hisayo Sugimoto, and other members of the public office in Hidakagawa Town; and Mrs. Tamako Tsutsumi, Mrs. Kanami Maeda, Mrs. Megumi Takino, Mrs. Shuko Okada, Mrs. Kazuyo Setoh, Mrs. Chise Ryouno, Mrs. Miki Shimosaki, Mrs. Chika Yamaguchi, Mrs. Yuki Shimoji, and other members of the public office in Taiji Town for their assistance in locating and scheduling participants for examinations. We would also like to thank Ms. Kyoko Yoshimura, Mrs. Toki Sakurai, Mrs. Saeko Sahara, and Mr. Noriyuki Oe for their assistance with data reduction and administration.

Funding

This work was supported by Grant-in-Aid funding from the Ministry of Health, Labour and Welfare: H17-Men-eki-009 (Director, Kozo Nakamura), H20-Choujyu-009 (Director, Noriko Yoshimura), H23-Choujyu-002 (Director, Toru Akune), H25-Choujyu-007 (Director, Noriko Yoshimura), and H25-Nanchitou (Men)-005 (Director, Sakae Tanaka). The study was also supported by Scientific Research grants B26293139, B23390172, B20390182, and Challenging Exploratory Research grants 15K15219, 24659317 to Noriko Yoshimura; Scientific Research grants B23390356, C20591774, and Challenging Exploratory Research grants 23659580 to Shigeyuki Muraki; Challenging Exploratory Research grants 24659666 and 21659349 and Young Scientists A18689031 to Hiroyuki Oka; Scientific Research grants B26293329, B23390357, C20591737 and Challenging Exploratory Research grants 25670293 to Toru Akune; and by Collaborating Research with NSF from the Ministry of Education, Culture, Sports, Science and Technology in Japan 08033011-00262 (Director, Noriko Yoshimura). The study was partly supported by grants from the Japan Agency for Medical Research and Development (17gk0210007h0003, Director, Sakae Tanaka). Further, the study was partly supported by grants from the Japan Osteoporosis Society (Noriko Yoshimura, Shigeyuki Muraki, Hiroyuki Oka, and Toru Akune), Japan Osteoporosis Foundation (2015, Noriko Yoshimura, and 2018, Chiaki Horii), research aids from the Japanese Orthopaedic Association (JOA-Subsidized Science Project Research 2006-1 and 2010-2, Director, Hiroshi Kawaguchi; and 2014-1, Director, Kozo Nakamura), the Japanese Society for Musculoskeletal Medicine (2015, Director, Shigeyuki Muraki; and 2017, Director, Noriko Yoshimura), Mitsui Sumitomo Insurance Welfare Foundation (2016, Director, Noriko Yoshimura), and Japan Dairy Association (2017, Director, Noriko Yoshimura).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Noriko Yoshimura.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (docx 16 kb)

About this article

Verify currency and authenticity via CrossMark

Cite this article

Horii, C., Asai, Y., Iidaka, T. et al. Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study. J Bone Miner Metab 37, 844–853 (2019). https://doi.org/10.1007/s00774-018-0981-5

Download citation

Keywords

  • Vertebral fracture
  • Prevalence
  • Low back pain
  • Walking ability
  • ROAD study