Vertebral fractures and mortality in older women: a prospective study

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Kado, Deborah M.¹; Browner, Warren S.²; Palermo, Lisa²; Nevitt, Michael C.²; Genant, Harry K.³; Cummings, Steven R.²

Vertebral fractures and mortality in older women: a prospective study

Arch Intern Med. June 14, 1999;159(11):1215-1220

©1999 American Medical Association. All rights reserved.

Affiliations

¹Geriatrics Division, Department of Medicine, University of California at Los Angeles

²Department of Epidemiology and Biostatistics, University of California at San Francisco

³Departments of Radiology, Medicine, and Orthopaedic Surgery, University of California at San Francisco
Abstract

Background: Osteoporotic fractures, including clinically detected vertebral fractures, are associated with increased mortality. However, only one third of vertebral fractures are diagnosed. It is unknown whether vertebral fractures, whether clinically apparent or not, are associated with greater mortality.

Objectives: To test the hypothesis that women with prevalent vertebral fractures have greater mortality than those without fractures and to describe causes of death associated with vertebral fractures.

Design: Prospective cohort study with mean follow-up of 8.3 years.

Setting: Four clinical centers in the United States.

Participants: A total of 9575 women aged 65 years or older and enrolled in the Study of Osteoporotic Fractures.

Measurements: Vertebral fractures by radiographic morphometry; calcaneal bone mineral density; demographic, medical history, and lifestyle variables; blood pressure; and anthropometric measures. In a subset of 606 participants, thoracic curvature was measured during a second clinic visit.

Main Outcome Measures: Hazard ratios for mortality and cause-specific mortality.

Results: At baseline, 1915 women (20.0%) were diagnosed as having vertebral fractures. Compared with women who did not have a vertebral fracture, women with 1 or more fractures had a 1.23-fold greater age-adjusted mortality rate (95% confidence interval, 1.10-1.37). Mortality rose with greater numbers of vertebral fractures, from 19 per 1000 woman-years in women with no fractures to 44 per 1000 woman-years in those with 5 or more fractures (P for trend, <.001). In particular, vertebral fractures were related to the risk of subsequent cancer (hazard ratio, 1.4; 95% confidence interval, 1.1-1.7) and pulmonary death (hazard ratio, 2.1; 95% confidence interval, 1.4-3.0). In the subset of women who underwent thoracic curvature measurements, severe kyphosis was also related to pulmonary deaths (hazard ratio, 2.6; 95% confidence interval, 1.3-5.1).

Conclusion: Women with radiographic evidence of vertebral fractures have an increased mortality rate, particularly from pulmonary disease and cancer.
Links

DOI: 10.1001/archinte.159.11.1215

PubMed: 10371229

WoS: 000080823800009
History

Accepted: 1998-10-01

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2021	Kim W, Nam GE, Han K, Jung J-H, Lee J, Park CM, Kim Y-H, Kim J-H, Kim SM, Park YG, Cho KH. Impact of waist circumference on the risk of vertebral fracture: a nationwide cohort study in South Korea. Bone. April 2021;145:115870.
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2020	Jansz TT, Goto NA, van Ballegooijen AJ, Willems HC, Verhaar MC, van Jaarsveld BC. The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone. Osteoporos Int. March 2020;31(3):515-524.
2020	Bassatne A, Harb H, Jaafar B, Romanos J, Ammar W, Fuleihan GE-H. Disease burden of osteoporosis and other non-communicable diseases in Lebanon. Osteoporos Int. September 2020;31(9):1769-1777.
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