Prevalent Vertebral Deformities Predict Hip Fractures and New Vertebral Deformities but Not Wrist Fractures


  • Dennis M. Black Ph.D.,

    Corresponding author
    • Department of Epidemiology and Biostatistics, University of California—San Francisco, 74 New Montgomery Street, Suite 600, San Franciso, CA 94105 U.S.A.
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  • Nigel K. Arden,

  • Lisa Palermo,

  • Jim Pearson,

  • Steven R. Cummings

  • This work was presented at the American Society for Bone and Mineral Research meeting, Kansas City, MO, U.S.A., September 1994.

  • Investigators and staff in the Study of Osteoporotic Fractures Research Group:

    University of California, San Francisco (Coordinating Center): Steven R. Cummings, M.D. (principal investigator), Michael C. Nevitt, Ph.D. (coinvestigator), Dennis M. Black, Ph.D. (coinvestigator, study statistician), Katie Stone, Ph.D. (project director), Harry K. Genant, M.D. (director, central radiology laboratory), Nigel Arden, M.D., Claude Arnaud, M.D., Douglas C. Bauer, M.D., Warren S. Browner, M.D., Lisa Christianson, R.N., Maurice Dockrell, Cary Fox, M.A., Robert Gore, Ph.D., Sarah Harvey, Mario Jaime-Chavez, Ph.D., Lee Laidlaw, Li-Yung Lui, M.A., M.S., Gabrielle Milani, Lisa Palermo, M.S., Ria San Valentin, M.D., Holly Tabor, Diana Tanaka, Clara Yeung.

    University of Maryland: J.C. Scott (principal investigator), R. Sherwin (coinvestigator), M.C. Hochberg (coinvestigator), J. Lewis (project director), E. Peddicord (clinic coordinator), A. Bauer, C. Boehm, G. Cullum, L. Finazzo, M.E. Flaks, T. Ford, D. Harris, B. Hohman, E. Oliner, T. Page, J. Schlossberg, C. Shaffer, A. Trimble, S. Trusty.

    University of Minnesota: K. Ensrud (principal investigator), P. Schreiner (coinvestigator), C. Bell (project director), E. Mitson (clinic coordinator), C. Bird, D. Blanks, S. Estill, S. Fillhouer, S. Fincham, J. Griffith, J. Hansen, F. Imker-Witte, K. Jacobson, K. Kiel, K. Knauth, N. Nelson, E. Penland-Miller, M. Riley-Alves.

    University of Pittsburgh: J.A. Cauley (principal investigator), L.H. Kuller (coprincipal investigator), M. Vogt (coinvestigator), L. Harper (project director), L. Buck (clinic coordinator), C. Bashada, D. Cusick, G. Engleka, A. Githens, M. Gorecki, K. McCune, D. Medve, M. Nasim, C. Newman, S. Rudovsky, N. Watson.

    The Kaiser Permanente Center for Health Research, Portland, Oregon: E. Harris (principal investigator, project director), W.M. Vollmer, E. Orwoll, H. Nelson (coinvestigators), Marge Erwin (project administrator, clinic coordinator), J. Bender, A. Doherty, K. Easter, M. Erwin, F. Heinith, J. Kann, K. Redden, C. Romero, K. Snider, C. Souvanlasy.


Although vertebral deformities are known to predict future vertebral deformities, little is known about their ability to predict other osteoporotic fractures. We examined the association between prevalent vertebral deformities and incident osteoporotic fractures in the Study of Osteoporotic Fractures, a prospective study of 9704 women aged 65 years and older. Prevalent vertebral deformities were determined morphometrically from spinal radiographs at baseline and incident deformities from repeat spinal radiographs after a mean of 3.7 years. Appendicular fractures were collected by postcard every 4 months for a mean of 8.3 years. During follow-up, 389 women with new vertebral deformities, 464 with hip fractures, and 574 with wrist fractures were identified. Prevalent vertebral deformities were associated with a 5-fold increased risk (relative risk 5.4, 95% confidence interval [CI] 4.4, 6.6) of sustaining a further vertebral deformity; the risk increased dramatically with both the number and severity of the prevalent deformities. Similarly, the risks of hip and any nonvertebral fractures were increased with baseline prevalent deformity, with relative risks of 2.8 (95% CI 2.3, 3.4) and 1.9 (95% CI 1.7, 2.1), respectively. Risk increased with number and severity of deformities. These associations remained significant after adjustment for age and calcaneal bone mineral density (BMD). Although there was a small increased risk of wrist fracture, this was not significant after adjusting for age and BMD. In conclusion, the presence of prevalent morphometrically defined vertebral deformities predicts future vertebral and nonvertebral fractures, including hip but not wrist fractures. Spinal radiographs identifying prevalent vertebral deformities may be a useful additional measurement to classify further a woman's risk of future fracture.