The authors have no conflict of interest
Determinants of the Size of Incident Vertebral Deformities in European Men and Women in the Sixth to Ninth Decades of Age: The European Prospective Osteoporosis Study (EPOS)†
Article first published online: 1 SEP 2003
Copyright © 2003 ASBMR
Journal of Bone and Mineral Research
Volume 18, Issue 9, pages 1664–1673, September 2003
How to Cite
Reeve, J. (2003), Determinants of the Size of Incident Vertebral Deformities in European Men and Women in the Sixth to Ninth Decades of Age: The European Prospective Osteoporosis Study (EPOS). J Bone Miner Res, 18: 1664–1673. doi: 10.1359/jbmr.2003.18.9.1664
- Issue published online: 2 DEC 2009
- Article first published online: 1 SEP 2003
- Manuscript Accepted: 26 NOV 2002
- Manuscript Revised: 25 OCT 2002
- Manuscript Received: 25 APR 2002
- vertebral fractures;
- cohort study;
- radiological morphometry;
- fracture risk
More severe vertebral fractures have more personal impact. In the European Prospective Osteoporosis Study, more severe vertebral collapse was predictable from prior fracture characteristics. Subjects with bi-concave or crush fractures at baseline had a 2-fold increase in incident fracture size and thus increased risk of a disabling future fracture.
Introduction: According to Euler's buckling theory, loss of horizontal trabeculae in vertebrae increases the risk of fracture and suggests that the extent of vertebral collapse will be increased in proportion. We tested the hypothesis that the characteristics of a baseline deformity would influence the size of a subsequent deformity.
Methods: In 207 subjects participating in the European Prospective Osteoporosis Study who suffered an incident spine fracture in a previously normal vertebra, we estimated loss of volume (fracture size) from plane film images of all vertebral bodies that were classified as having a new fracture. The sum of the three vertebral heights (anterior, mid-body, and posterior) obtained at follow-up was subtracted from the sum of the same measures at baseline. Each of the summed height loss for vertebrae with a McCloskey-Kanis deformity on the second film was expressed as a percentage.
Results and Conclusions: In univariate models, the numbers of baseline deformities and the clinical category of the most severe baseline deformity were each significantly associated with the size of the most severe incident fracture and with the cumulated sum of all vertebral height losses. In multivariate modeling, age and the clinical category of the baseline deformity (crush > bi-concave > uni-concave > wedge) were the strongest determinants of both more severe and cumulative height loss. Baseline biconcave and crush fractures were associated at follow-up with new fractures that were approximately twice as large as those seen with other types of deformity or who previously had undeformed spines. In conclusion, the characteristics of a baseline vertebral deformity determines statistically the magnitude of vertebral body volume lost when a subsequent fracture occurs. Because severity of fracture and number of fractures are determinants of impact, the results should improve prediction of the future personal impact of osteoporosis once a baseline prevalent deformity has been identified.