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Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014

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Abstract

Summary

Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them.

Introduction

Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data.

Methods

Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013–2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected.

Results

Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA.

Conclusion

Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.

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Acknowledgements

Financial support for the collection of osteoporosis-related data in NHANES 2013–2014 was provided by Eli Lilly and Company through a grant to the CDC Foundation. Eli Lilly and Company had no role in the collection of the data or the production of the public use datasets. The authors appreciate and acknowledge the contribution of Meng Lian in providing expert vertebral fracture assessment and Barbara Coffey, at Eli Lilly and Company, for manuscript process support.

Author information

Authors and Affiliations

  1. Regional Bone Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY, 10993, USA

    F. Cosman

  2. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    F. Cosman

  3. Eli Lilly and Company, Indianapolis, IN, USA

    J. H. Krege & K. D. Krohn

  4. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA

    A. C. Looker & N. Sarafrazi Isfahani

  5. HealthPartners Institute and Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA

    J. T. Schousboe

  6. Department of Radiology, University of California, San Francisco, CA, USA

    B. Fan, J. A. Shepherd & H. K. Genant

  7. Parexel International, Waltham, MA, USA

    P. Steiger

  8. Hologic, Inc., Marlborough, MA, USA

    K. E. Wilson

Authors
  1. F. Cosman
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  2. J. H. Krege
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  3. A. C. Looker
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  4. J. T. Schousboe
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  9. P. Steiger
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  11. H. K. Genant
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Corresponding author

Correspondence to F. Cosman.

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Financial disclosure

Dr. Cosman is a consultant to Lilly, Amgen, Merck, Radius, and Tarsa, has received grants (funding and/or medication) from Lilly and Amgen, and is a speaker for Lilly and Amgen. Drs. Krege and Krohn are employees and stockholders of Eli Lilly and Company. Dr. Shepherd has received grants from Amgen, Merck, and Hologic. Dr. Steiger is a stockholder of Optasia Medical. Dr. Wilson is an employee and stockholder of Hologic, Inc. Dr. Genant is a consultant to Lilly, Amgen, Merck, Janssen, Regeneron, Medtronic, AgNovos, BioMarin, Medimune, and BioClinica. Drs. Looker, Schousboe, Fan, and Sarafrazi Isfahani have no financial disclosures.

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Additional information

Felicia Cosman and John H. Krege contributed equally.

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The findings and conclusions in this report are those of the authors and not necessarily those of the Centers for Disease Control and Prevention.

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Cosman, F., Krege, J.H., Looker, A.C. et al. Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 28, 1857–1866 (2017). https://doi.org/10.1007/s00198-017-3948-9

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