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Senior Citizen Health & Medicine
Vertebra Fracture More Likely in Older Women with
Osteoporosis and Previous Fracture
First evidence of increased risk over the long-term
reported by JAMA
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Watch JAMA Video |
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 Spine
fractures are the most common kind of bone fractures caused by
osteoporosis - about seven-hundred thousand each year in U.S.
But about two-thirds go undiagnosed. A new study aims to help
identify women at greatest risk for those fractures, in hopes of
preventing them. Mavis Prall explains in this JAMA Report. Watch
Video |
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Dec. 26, 2007 - Over a 15 year period, elderly
women with low bone mineral density, and a previous vertebra fracture,
had an increased risk of a new vertebra fracture, when compared to women
with normal bone mineral density and no previous fracture, according to
a study in the December 19 issue of the Journal of the American Medical
Association (JAMA).
Vertebral fractures are the most common
osteoporotic fracture, with prevalence estimates of 35 percent to 50
percent among women older than 50 years. About 700,000 vertebral
fractures occur each year in the United States, according to background
information in the article.
Women with low bone mineral density (BMD) and
previous vertebral fractures have a greater risk of new vertebral
fractures over the short-term, but their risk of vertebral fracture over
the long-term was unknown before this study.
Jane A. Cauley, Dr.P.H., of the University of
Pittsburgh, and colleagues examined the absolute risk of new vertebral
fractures by spine and hip BMD and previous vertebral fracture status
over 15 years of follow-up in a group of 9,704 white women, who were
recruited at four U.S. clinical centers and enrolled in the Study of
Osteoporotic Fractures. Of these, 2,680 attended a clinic visit an
average of 14.9 years after entering the study.
The average age of the women was 68.8 years at
entry and 83.8 years at follow-up.
The researchers found that of these 2,680 women,
487 (18.2 percent) experienced a new vertebral fracture, including 163
(41.4 percent) of the 394 with a previous vertebral fracture at the
beginning of the study and 324 (14.2 percent) of the 2,286 without a
previous vertebral fracture at baseline.
Women who experienced a new fracture also weighed
less, were more likely to have a positive fracture history and a
previous vertebral fracture at study entry, and less likely to report
estrogen use at baseline.
Women with a previous vertebral fracture at
baseline had more than four times the odds of experiencing a new
vertebral fracture over follow-up compared with women without a previous
vertebral fracture at baseline. The risk was greatest among women with
two or more previous fractures at baseline.
Low BMD was a strong predictor of new vertebral
fracture. About one-third of women with a low hip BMD measurement had a
new vertebral fracture, compared with about 10 percent of women with
normal BMD.
The absolute risk of vertebral fractures was 56
percent among women with both a previous vertebral fracture and BMD in
the osteoporotic range. In contrast, women with normal BMD and no
previous fracture had an absolute risk of about 9 percent.
Our results support the recommendation that older
women with a prevalent vertebral fracture should be treated for
osteoporosis irrespective of BMD. Treatment of women with prevalent
asymptomatic vertebral fractures with bisphosphonates and selective
estrogen receptors modulators has been shown to decrease fracture
incidence, the authors write.
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