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Predictors of new and severe vertebral fractures: results from the HORIZON Pivotal Fracture Trial

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Abstract

Summary

We examined prevalent and recent vertebral fractures in 1 year as predictors of new vertebral fractures over subsequent 2 years using data from RCT placebo patients. We found that prevalent and recent vertebral fractures strongly and independently predicted subsequent vertebral fractures including those which were severe.

Introduction

While several studies have shown that prevalent vertebral fractures (pVFx) increase the risk of new vertebral fractures (VFx), the impact of recent vertebral fractures on future fractures is less studied.

Methods

Data from the placebo arm of the HORIZON Pivotal Fracture Trial, an international trial of zoledronic acid in postmenopausal, osteoporotic women between 65 and 85 years, were used. We included the subset of 2677 women with annual spinal radiographs to study the impact of vertebral fractures in year 1 (Y1 VF) on those occurring in years 2 and 3 using morphometric and semiquantitative (SQ) criteria. In addition, a subset of severe VFx was defined using SQ criteria. Logistic regression examined the impact of pVFx and Y1 VF on all incident VFx and on severe incident VFx.

Results

Two hundred fourty-five (9.1%) women sustained a new VFx in years 2–3. VFx risk in years 2–3 was 3.9% in those without pVFx or VFy1 and 29.8% in those with both risk factors. Both pVF and VFy1 remained independent predictors for future VF when they were both entered into a logistic regression model (odds ratio (OR) = 3.3; 95% confidence interval (CI), 2.3–4.7; OR = 3.7, 95% CI, 2.3, 5.8, respectively). ORs were similar after adjustment. Of the total number of women, 4.1% had severe VFx. PVFx and Y1 VF were also significant predictors of severe VFx; however, Y1 VF appeared more strongly predictive of severe VFx.

Conclusions

Prevalent and incident vertebral fractures are highly predictive of subsequent new and severe vertebral fractures. Women with both of these risk factors are likely to benefit from anti-osteoporosis treatment.

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References

  1. Burge R, Dawson-Hughes B, Solomon D, Wong J, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  2. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16:3–7

    Article  Google Scholar 

  3. Kanis J, Johnell O, Oden A, Borgstrom F, Zethraeus N, Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    Article  PubMed  CAS  Google Scholar 

  4. Nevitt M, Ettinger B, Black D, Stone K, Jamal S, Ensrud K, Segal M, Genant H, Cummings S (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793

    PubMed  CAS  Google Scholar 

  5. Hasserius R, Karlsson M, Jonsson B, Redlund-Johnell I, Johnell O (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly—a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76:235–242

    Article  PubMed  CAS  Google Scholar 

  6. Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women. Osteoporos Int 16:2175–2179

    Article  PubMed  CAS  Google Scholar 

  7. Black D, Arden N, Palermo L, Pearson J, Cummings S (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  8. Cauley J, Hochberg M, Lui L, Palermo L, Ensrud K, Hillier T, Nevitt M, Cummings S (2007) Long-term risk of incident vertebral fractures. Jama 298:2761

    Article  PubMed  CAS  Google Scholar 

  9. Delmas P, Genant H, Crans G, Stock J, Wong M, Siris E, Adachi J (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532

    Article  PubMed  CAS  Google Scholar 

  10. Hasserius R, Karlsson M, Nilsson B, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68

    Article  PubMed  CAS  Google Scholar 

  11. Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    Article  PubMed  CAS  Google Scholar 

  12. Lindsay R, Silverman S, Cooper C, Hanley D, Barton I, Broy S, Licata A, Benhamou L, Geusens P, Flowers K (2001) Risk of new vertebral fracture in the year following a fracture. Jama 285:320

    Article  PubMed  CAS  Google Scholar 

  13. Naves M, Diaz-Lopez J, Gomez C, Rodriguez-Rebollar A, Rodriguez-Garcia M, Cannata-Andia J (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–524

    Article  PubMed  CAS  Google Scholar 

  14. Cummings S, Browner W, Black D, Nevitt M, Genant H, Cauley J, Ensrud K, Scott J, Vogt T (1993) Bone density at various sites for prediction of hip fractures. Lancet 341:72–75

    Article  PubMed  CAS  Google Scholar 

  15. Cummings S, Nevitt M, Browner W, Stone K, Fox K, Ensrud K, Cauley J, Black D, Vogt T (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. Crans GG, Genant HK, Krege JH (2005) Prognostic utility of a semiquantitative spinal deformity index. Bone 37:175–179

    Article  PubMed  Google Scholar 

  18. Kerkeni S, Kolta S, Fechtenbaum J, Roux C (2009) Spinal deformity index (SDI) is a good predictor of incident vertebral fractures. Osteoporos Int 20:1547–1552

    Article  PubMed  CAS  Google Scholar 

  19. Lunt M, O’Neill T, Felsenberg D, Reeve J, Kanis J, Cooper C, Silman A (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513

    Article  PubMed  Google Scholar 

  20. Black D, Delmas P, Eastell R, Reid I, Boonen S, Cauley J, Cosman F, Lakatos P, Leung P, Man Z (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809

    Article  PubMed  CAS  Google Scholar 

  21. Genant H, Wu C, Van Kuijk C, Nevitt M (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  PubMed  CAS  Google Scholar 

  22. Black D, Palermo L, Nevitt M, Genant H, Epstein R, San Valentin R, Cummings S (1995) Comparison of methods for defining prevalent vertebral deformities: the Study of Osteoporotic Fractures. J Bone Mine Res 10:890–902

    Article  CAS  Google Scholar 

  23. Black D, Palermo L, Nevitt M, Genant H, Christensen L, Cummings S (1999) Defining incident vertebral deformity: a prospective comparison of several approaches. J Bone Miner Res 14:90–101

    Article  PubMed  CAS  Google Scholar 

  24. Minne H, Leidig G, Wüster C, Siromachkostov L, Baldauf G, Bickel R, Sauer P, Lojen M, Ziegler R (1988) A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 3:335

    PubMed  CAS  Google Scholar 

  25. Johnell O, Kanis J (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  PubMed  CAS  Google Scholar 

  26. Chesnut C III, Skag A, Christiansen C, Recker R, Stakkestad J, Hoiseth A, Felsenberg D, Huss H, Gilbride J, Schimmer R (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249

    Article  CAS  Google Scholar 

  27. Cummings S, Martin J, McClung M, Siris E, Eastell R, Reid I, Delmas P, Zoog H, Austin M, Wang A (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756

    Article  PubMed  CAS  Google Scholar 

  28. Neer R, Arnaud C, Zanchetta J, Prince R, Gaich G, Reginster J, Hodsman A, Eriksen E, Ish-Shalom S, Genant H (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434

    Article  PubMed  CAS  Google Scholar 

  29. Harris S, Watts N, Genant H, McKeever C, Hangartner T, Keller M, Chesnut C III, Brown J, Eriksen E, Hoseyni M (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Jama 282:1344

    Article  PubMed  CAS  Google Scholar 

  30. Black D, Thompson D, Bauer D, Ensrud K, Musliner T, Hochberg M, Nevitt M, Suryawanshi S, Cummings S (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 85:4118

    Article  PubMed  CAS  Google Scholar 

  31. Black D, Cummings S, Karpf D, Cauley J, Thompson D, Nevitt M, Bauer D, Genant H, Haskell W, Marcus R (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541

    Article  PubMed  CAS  Google Scholar 

  32. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi J (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35(5):293–305

    Article  PubMed  CAS  Google Scholar 

  33. Papaioannou A, Kennedy C, Ioannidis G, Gao Y, Sawka A, Goltzman D, Tenenhouse A, Pickard L, Olszynski W, Davison K (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587

    Article  PubMed  CAS  Google Scholar 

  34. Bessette L, Ste-Marie L, Jean S, Davison K, Beaulieu M, Baranci M, Bessant J, Brown J (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19:79–86

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The HORIZON-PFT was funded by Novartis Pharmaceuticals. Funding for this analysis of vertebral fracture prediction was provided by Medtronic.

Conflicts of interest

Dennis Black has research support from Novartis Pharmaceuticals.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA, 94107, USA

    R. Wustrack, S. Burch, L. Palermo & D. M. Black

  2. Austin Health, University of Melbourne, Melbourne, Australia

    E. Seeman

  3. Novartis Pharmaceuticals Corp, East Hanover, NJ, USA

    C. Bucci-Rechtweg

Authors
  1. R. Wustrack
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  2. E. Seeman
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  3. C. Bucci-Rechtweg
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  4. S. Burch
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  5. L. Palermo
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  6. D. M. Black
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Correspondence to D. M. Black.

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Wustrack, R., Seeman, E., Bucci-Rechtweg, C. et al. Predictors of new and severe vertebral fractures: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int 23, 53–58 (2012). https://doi.org/10.1007/s00198-011-1664-4

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  • DOI: https://doi.org/10.1007/s00198-011-1664-4

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