J Korean Med Sci.  2020 Apr;35(17):e116. 10.3346/jkms.2020.35.e116.

Impact of Bone Mineral Density on the Incidence of Age-Related Vertebral Fragility Fracture

• Lee J
• Chang G
• Kang H
• Ham DW
• Lee JS
• Jung HS
• Song KS

• KMID: 2500209
• DOI: http://doi.org/10.3346/jkms.2020.35.e116

Abstract

Background
Vertebral fragility fracture (VFF) is a common fracture related to osteoporosis. However, VFF might be asymptomatic and often occurs in patients without osteoporosis. Therefore, we investigated the characteristics of age-related VFF and their correlation with bone mineral density (BMD). Furthermore, we analyzed other factors affecting VFF
Methods
Medical records from a single center were retrospectively reviewed for 2,216 patients over 50 years old with vertebral fractures conservatively treated from 2005 to 2016. Patients' age, gender, body mass index (BMI), BMD, fracture level, previous vertebral fractures, and anti-osteoporosis medications were obtained. Patients were divided into fragility/non-fragility groups and age sub-groups. The odds ratio for VFF in relation to BMD was evaluated. We also identified other predictive factors for VFF by age groups.
Results
The fragility group had a higher women ratio, older age, lower BMI, lower BMD, and greater incidence of previous vertebral fractures than the non-fragility group. VFFs were seen in 41.18% of normal BMD patients aged 50–59 and 67.82% of those aged 60–69. The proportion of VFFs increased with age in all WHO osteoporosis classifications. Patients with osteopenia and osteoporosis were 1.57 and 2.62 fold more likely to develop VFFs than normal BMD. In the younger group (under 70), age, women, BMD, and previous vertebral fracture were significant factors affecting VFF, and in the older group (70 and over), age, women, and BMD were factors. In the fragility group, anti-osteoporosis medication rates were 25.08% before and 45.96% after fracture.
Conclusion
Considerable VFFs occurred in the younger age groups without osteoporosis and age itself was another important predictor of VFF especially in older age groups. The discrepancy between the incidence of VFF and BMD suggests the necessity of supplemental screening factors and anti-osteoporosis treatment guidelines using only BMD should be reconsidered.

Keyword

Vertebral Fracture; Fragility Fracture; Bone Mineral Density; Osteoporosis Medication; Incidence; Fracture Risk

Figure

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  Fig. 1 Flow chart of the study.DXA = dual energy X-ray absorptiometry, BMD = bone mineral density, BMI = body mass index.

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  Fig. 2 Percentage of vertebral fragility and non-fragility fractures by age group. The proportion of fragility fractures tended to increase with higher age group.

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  Fig. 3 Proportion of fragility fractures by age and WHO osteoporosis classifications using bone mineral density. The percentage of fragility fractures tended to be higher in subgroups with higher age, regardless of WHO osteoporosis classification.WHO = World Health Organization.

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  Fig. 4 Annual anti-osteoporosis prescription rates in 1,930 fragility group patients before and after fracture. Prescription rates ranged from 17.42% to 38.61% before fracture and 32.24 to 68.06% after fracture. In 2016, the prescription rate after fracture increased significantly compared to previous years.

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