Skip to main content
SpringerLink
Log in

Prevalence of asymptomatic radiographic vertebral fracture in postmenopausal Thai women

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

We aim to investigate the nationwide prevalence of asymptomatic radiographic vertebral fracture in Thailand. We found 29% of postmenopausal women had at least one radiographic vertebral fracture. The prevalence was significantly higher among women with osteoporosis at the total hip (TH) region which implies that TH bone mineral density is a determinant of vertebral fracture risk.

Introduction

Radiographic vertebral fracture is associated with an increased risk of osteoporotic fracture and mortality in postmenopausal women. We designed a study to determine the prevalence of asymptomatic vertebral fractures in postmenopausal Thai women.

Methods

The study was designed as a cross-sectional investigation at five university hospitals so as to achieve representation of the four main regions of Thailand. Radiographs were taken from 1062 postmenopausal women averaging 60 years of age. The presence of vertebral fracture was assessed by the Genant’s semiquantitative method with three independent radiologists. Respective bone mineral density was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS), femoral neck (FN), and total hip (TH).

Results

Among the 1062 women, 311 were found to have at least one radiographic vertebral fracture—yielding a prevalence of 29% (95% CI 23.6–32.0%)—and 90 (8.5%, 95% CI 6.8–10.2%) had at least two fractures. The prevalence of vertebral fracture increased with advancing age. Most fractures occurred at one vertebra (71%) and only 29% at multiple vertebrae. The prevalence of vertebral fracture was significantly higher among women with osteoporosis compared with non-osteoporosis at the TH region. There was no significant difference in the prevalence among women with or without osteoporosis at the LS or FN.

Conclusions

Radiographic vertebral fractures were common among Thai postmenopausal women (~ 29%). These findings suggest that approximately one in three postmenopausal women has undiagnosed vertebral fracture. Radiographic diagnosis should therefore be an essential investigation for identifying and confirming the presence of vertebral fractures.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Melton LJ, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011. https://doi.org/10.1093/oxfordjournals.aje.a115204

    Article  PubMed  Google Scholar 

  2. 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 11:1010–1018. https://doi.org/10.1002/jbmr.5650110719

    Article  PubMed  Google Scholar 

  3. Melton LJ, Atkinson EJ, Cooper C et al (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221. https://doi.org/10.1007/s001980050218

    Article  PubMed  Google Scholar 

  4. 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 

  5. Burger H, van Daele PL, Algra D et al (1994) Vertebral deformities as predictors of non-vertebral fractures. BMJ 309:991–992. https://doi.org/10.1136/bmj.309.6960.991

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cooper C, Melton LJ (1992) Vertebral fractures. BMJ 304:793–794. https://doi.org/10.1136/bmj.304.6830.793

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, Cahall DL, IMPACT Study Group (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563. https://doi.org/10.1359/JBMR.041214

    Article  PubMed  Google Scholar 

  8. 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. https://doi.org/10.1007/s001980070078

    Article  CAS  PubMed  Google Scholar 

  9. Ling X, Cummings SR, Mingwei Q, Xihe Z, Xioashu C, Nevitt M, Stone K (2000) Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project. J Bone Miner Res 15:2019–2025. https://doi.org/10.1359/jbmr.2000.15.10.2019

    Article  CAS  PubMed  Google Scholar 

  10. Ross PD, Fujiwara S, Huang C et al (1995) Vertebral fracture prevalence in women in Hiroshima compared to Caucasians or Japanese in the US. Int J Epidemiol 24:1171–1177. https://doi.org/10.1093/ije/24.6.1171

    Article  CAS  PubMed  Google Scholar 

  11. Kitazawa A, Kushida K, Yamazaki K, Inoue T (2001) Prevalence of vertebral fractures in a population-based sample in Japan. J Bone Miner Metab 19:115–118. https://doi.org/10.1007/s007740170049

    Article  CAS  PubMed  Google Scholar 

  12. 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 45:213–217. https://doi.org/10.1016/j.bone.2009.04.199

    Article  PubMed  Google Scholar 

  13. Lau EM, Chan YH, Chan M et al (2000) Vertebral deformity in Chinese men: prevalence, risk factors, bone mineral density, and body composition measurements. Calcif Tissue Int 66:47–52. https://doi.org/10.1007/s002230050009

    Article  CAS  PubMed  Google Scholar 

  14. Tsai K, Twu S, Chieng P et al (1996) Prevalence of vertebral fractures in Chinese men and women in urban Taiwanese communities. Calcif Tissue Int 59:249–253. https://doi.org/10.1007/s002239900118

    Article  CAS  PubMed  Google Scholar 

  15. 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 11:1364–1368. https://doi.org/10.1002/jbmr.5650110922

    Article  CAS  PubMed  Google Scholar 

  16. Trivitayaratana W, Trivitayaratana P, Bunyaratave N (2005) Quantitative morphometric analysis of vertebral fracture severity in healthy Thai (women and men). J Med Assoc Thail 88(Suppl 5):S1–S7

    Google Scholar 

  17. 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 8:251–258. https://doi.org/10.1111/j.1447-0594.2008.00475.x

    Article  PubMed  Google Scholar 

  18. Skov T, Deddens J, Petersen MR, Endahl L (1998) Prevalence proportion ratios: estimation and hypothesis testing. Int J Epidemiol 27:91–95. https://doi.org/10.1093/ije/27.1.91

    Article  CAS  PubMed  Google Scholar 

  19. Hammami M, Picaud J-C, Fusch C, Hockman EM, Rigo J, Koo WWK (2002) Phantoms for cross-calibration of dual energy X-ray absorptiometry measurements in infants. J Am Coll Nutr 21:328–332. https://doi.org/10.1080/07315724.2002.10719230

    Article  PubMed  Google Scholar 

  20. Reid DM, Mackay I, Wilkinson S, Miller C, Schuette DG, Compston J, Cooper C, Duncan E, Galwey N, Keen R, Langdahl B, McLellan A, Pols H, Uitterlinden A, O’Riordan J, Wass JAH, Ralston SH, Bennett ST (2006) Cross-calibration of dual-energy X-ray densitometers for a large, multi-center genetic study of osteoporosis. Osteoporos Int 17:125–132. https://doi.org/10.1007/s00198-005-1936-y

    Article  CAS  PubMed  Google Scholar 

  21. Limpaphayom KK, Taechakraichana N, Jaisamrarn U, Bunyavejchevin S, Chaikittisilpa S, Poshyachinda M, Taechamahachai C, Havanond P, Onthuam Y, Lumbiganon P, Kamolratanakul P (2000) Bone mineral density of lumbar spine and proximal femur in normal Thai women. J Med Assoc Thail 83:725–731

    CAS  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872. https://doi.org/10.1002/(sici)1097-0258(19980430)17:8<857::aid-sim777>3.0.co;2-e

    Article  CAS  PubMed  Google Scholar 

  24. Pongchaiyakul C, Songpattanasilp T, Taechakraichana N (2008) Burden of osteoporosis in Thailand. J Med Assoc Thail 91:261–267

    Google Scholar 

  25. Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–192. https://doi.org/10.1007/s00198-006-0211-1

    Article  CAS  PubMed  Google Scholar 

  26. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828. https://doi.org/10.1359/jbmr.1999.14.5.821

    Article  CAS  PubMed  Google Scholar 

  27. Clark P, Cons-Molina F, Deleze M, Ragi S, Haddock L, Zanchetta JR, Jaller JJ, Palermo L, Talavera JO, Messina DO, Morales-Torres J, Salmeron J, Navarrete A, Suarez E, Pérez CM, Cummings SR (2009) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 20:275–282. https://doi.org/10.1007/s00198-008-0657-4

    Article  CAS  PubMed  Google Scholar 

  28. 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 6:883–892. https://doi.org/10.1002/jbmr.5650060814

    Article  CAS  PubMed  Google Scholar 

  29. Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporos Int 16:717–728. https://doi.org/10.1007/s00198-005-1880-x

    Article  CAS  PubMed  Google Scholar 

  30. Grados F, Roux C, de Vernejoul MC, Utard G, Sebert JL, Fardellone P (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722. https://doi.org/10.1007/s001980170046

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the patients for their participation and the hospitals and their respective staff members for their assistance and Mr. Bryan Roderick Hamman and Mrs. Janice Loewen-Hamman for their assistance with the English-language presentation of the manuscript.

Funding

This study was financially supported by the Thai Osteoporosis Foundation (TOPF).

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Chatlert Pongchaiyakul & Suranut Charoensri

  2. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Taninnit Leerapun

  3. Department of Orthopaedics and Physical Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

    Sunton Wongsiri

  4. Department of Orthopaedics, Phramongkutklao College of Medicine, Phramongkutklao Hospital, Bangkok, Thailand

    Thawee Songpatanasilp

  5. Menopausal Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Nimit Taechakraichana

Authors
  1. Chatlert Pongchaiyakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suranut Charoensri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taninnit Leerapun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sunton Wongsiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thawee Songpatanasilp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nimit Taechakraichana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chatlert Pongchaiyakul.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pongchaiyakul, C., Charoensri, S., Leerapun, T. et al. Prevalence of asymptomatic radiographic vertebral fracture in postmenopausal Thai women. Arch Osteoporos 15, 78 (2020). https://doi.org/10.1007/s11657-020-00762-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-020-00762-z

Keywords

Search

Navigation