Abstract
Summary
In women older than 60 years with clinical risk factors for osteoporosis but without osteoporosis based on bone mineral density (T-score ≥ −2.5), a systematic survey with X-rays of the spine identified previously unknown vertebral deformities in 21% of women.
Introduction
This study determines the prevalence of vertebral deformities in elderly women with clinical risk factors for osteoporosis but with BMD values above the threshold for osteoporosis (T-score ≥ −2.5).
Methods
Bisphosphonate naïve women older than 60 years attending 35 general practices in the Netherlands with ≥2 clinical risk factors for osteoporosis were invited for BMD measurement (DXA). In women with T-score ≥ −2.5 at both spine and the hips, lateral radiographs of the thoracic and lumbar spine were performed.
Results
Of 631 women with a DXA measurement, 187 (30%) had osteoporosis (T-score < −2.5 at the spine or the hip). Of the remaining 444 women with T-score ≥ −2.5 at both spine and hip, 387 had additional spine radiographs, of whom 80 (21%) had at least one vertebral deformity.
Conclusion
In elderly women with clinical risk factors for osteoporosis but BMD T-score ≥ −2.5, addition of spine radiographs identified vertebral deformities in 21% (95% CI: 17–25). Since these women are at risk of future fractures, antiosteoporotic treatment should be considered.
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References
Anon (2002) America’s bone health: the state of osteoporosis and low bone mass in our nation. National Osteoporosis Foundation, Washington (DC)
Anon (2004) Bone health and osteoporosis: a report of the surgeon general. Rockville (MD): US Department of Health and Human Services, Office of the Surgeon General. Available at http://www.surgeongeneral.gov/library/bonehealth/ [last accessed 7 June 2007]
RIVM osteoporosis fact sheath, available at http://www.rivm.nl/vtv/object_document/o1793n18373.html [last accessed at 7 June 2007]
Hofman A, Boerlage PA, Bots ML et al (1995) Prevalence of chronic diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly). Ned Tijdschr Geneeskd 139(39):1975–1978
Geusens PP, Lems WF, Verhaar HJ et al (2006) Review and evaluation of the Dutch guidelines for osteoporosis. J Eval Clin Pract 12(5):539–548
Kaptoge S, Armbrecht G, Felsenberg D et al (2006) Whom to treat? The contribution of veretebral X-rays to risk-based algorithms for fracture prediction: results from the European Prospective Osteoporosis Study. Osteoporos Int 17(9):1369–1381
CBO Guideline Osteoporosis; second revised guideline. Available at http://www.cbo.nl/product/richtlijnen/folder20021023121843/osteoporose.pdf/view
Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitometry 3(3):281–290
Siris ES, Miller PD, Barrett-Connor E et al (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA 286(22):2815–2822
Miller PD, Siris ES, Barrett-Connor E et al (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17(12):2222–2230
Schuit SC, van der Klift M, Weel AE et al (2004) Fracture incidence and association with bone mineral density in elderly men and women. The Rotterdam Study. Bone 34(1):195–202
Sornay-Rendu E, Munoz F, Garnero P Duboeuf F, Delmas PD (2005) Identification of Osteopenic Women at High Risk of Fracture: The OFELY Study. J Bone Miner Res 20(10):1813–1819
Siris ES, Genant HK, Laster AJ et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18(6):761–777
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(5):821–828
Ismail AA, Cockerill W, Cooper C et al (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12(2):85–90
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–39
Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382
Lems WF (2007) Clinical relevance of vertebral fractures. Ann Rheum Dis 66(1):2–4
Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397
Khosla S, Melton LJ III (2007) Clinical practice. Osteopenia. N Engl J Med 356(22):2293–2300
Chapurlat RD, Duboeuf F, Marion-Audibert HO et al (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporosis Int 17(8):1189–1195
Vosse D, Heijckmann C, Landewé R et al (2007) Comparing morphometric X-ray absorptiometry and radiography in defining vertebral wedge fractures in patients with ankylosing spondylitis. Rheumatology (Oxford) 46(11):1667–1671
Acknowledgments
This study was supported and funded by F. Hoffmann-LaRoche, Ltd. and GlaxoSmithKline. The authors would like to acknowledge Nicole van de Griend, MSc, and Carien Gierveld, MSc, of GlaxoSmithKline for research assistance.
Conflicts of interest
This study was supported and funded by Roche and GSK. Dr J.C. Netelenbos, Dr W.F. Lems, Dr P.P. Geusens, Dr H.J. Verhaar, Dr A.J.M. Boermans, and Dr S.E. Papapoulos have no conflict of interest, including specific financial interest and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript. Dr M.M. Boomsma is an employee of GSK. Dr P.G.H. Mulder has served as a consultant for GSK.
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Netelenbos, J.C., Lems, W.F., Geusens, P.P. et al. Spine radiographs to improve the identification of women at high risk for fractures. Osteoporos Int 20, 1347–1352 (2009). https://doi.org/10.1007/s00198-008-0801-1
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DOI: https://doi.org/10.1007/s00198-008-0801-1