Important risk factors and attributable risk of vertebral fractures in the population-based Tromsø study

BMC Musculoskeletal Disorders

Nina Emaus³  Anne J Søgaard⁵  John A Eisman²  Nguyen D Nguyen⁴  Bente Morseth¹  Jacqueline R Center²  Luai A Ahmed³  Tuan Nguyen⁴  Svanhild Waterloo¹ 

[1] Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, 9037, Norway;St. Vincent’s Hospital, Sydney, Australia;Department of Health and Care Sciences, University of Tromsø, 9037, Tromsø, Norway;Garvan Institute of Medical Research, University of New South Wales, Sydney, Australia;Norwegian Institute of Public Health, Oslo, Norway

关键词: Population attributable risk (par);    Population based study;    Risk factors;    Vertebral fractures;    Morphometry;   

Others  :  1145906
DOI  :  10.1186/1471-2474-13-163

 received in 2012-02-06, accepted in 2012-08-27,  发布年份 2012

【 摘 要 】

Background

Vertebral fractures, the most common type of osteoporotic fractures, are associated with increased risk of subsequent fracture, morbidity, and mortality. The aim of this study was to examine the contribution of important risk factors to the variability in vertebral fracture risk.

Methods

Vertebral fracture was ascertained by VFA method (DXA, GE Lunar Prodigy) in 2887 men and women, aged between 38 and 87 years, in the population-based Tromsø Study 2007/2008. Bone mineral density (BMD; g/cm²) at the hip was measured by DXA. Lifestyle information was collected by questionnaires. Multivariable logistic regression model, with anthropometric and lifestyle factors included, was used to assess the association between each or combined risk factors and vertebral fracture risk. Population attributable risk was estimated for combined risk factors in the final multivariable model.

Results

In both sexes, age (odds ratio [OR] per 5 year increase: 1.32; 95% CI 1.19-1.45 in women and 1.21; 95% CI 1.10-1.33 in men) and BMD (OR per SD decrease: 1.60; 95% CI 1.34-1.90 in women and1.40; 95% CI 1.18-1.67 in men) were independent risk factors for vertebral fracture. At BMD levels higher than 0.85 g/cm², men had a greater risk of fracture than women (OR 1.52; 95% CI 1.14-2.04), after adjusting for age. In women and men, respectively, approximately 46% and 33% of vertebral fracture risk was attributable to advancing age (more than 70 years) and low BMD (less than 0.85 g/cm²), with the latter having a greater effect than the former.

Conclusions

These data confirm that age and BMD are major risk factors for vertebral fracture risk. However, in both sexes the two factors accounted for less than half of fracture risk. The identification of individuals with vertebral fracture is still a challenge.

【 授权许可】

   
2012 Waterloo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Harvey N, Dennison E, Cooper C: Osteoporosis: impact on health and economics. Nat Rev Rheumatol 2010, 6(2):99-105.
• [2]Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR: Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009, 301(5):513-521.
• [3]Ahmed LA, Schirmer H, Bjornerem A, Emaus N, Jorgensen L, Stormer J, Joakimsen RM: The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromso, Norway. Eur J Epidemiol 2009, 24(8):441-448.
• [4]Johnell O, Kanis J: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006, 17(12):1726-1733.
• [5]Francis R, Aspray T, Hide G, Sutcliffe A, Wilkinson P: Back pain in osteoporotic vertebral fractures. Osteoporos Int 2008, 19(7):895-903.
• [6]El Maghraoui A, Mounach A, Rezqi A, Achemlal L, Bezza A, Ghozlani I: Vertebral fracture assessment in asymptomatic men and its impact on management. Bone 2012, 50(4):853-857.
• [7]Center JR, Bliuc D, Nguyen TV, Eisman JA: Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007, 297(4):387-394.
• [8]Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, et al.: Risk of new vertebral fracture in the year following a fracture. JAMA 2001, 285(3):320-323.
• [9]Naves M, Díaz-López JB, Gómez C, Rodríguez-Rebollar A, Rodríguez-García M, Cannata-Andía JB: The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 2003, 14(6):520-524.
• [10]Briggs A, Greig A, Wark J: The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int 2007, 18(5):575-584.
• [11]Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M: Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 2007, 18(12):1617-1624.
• [12]Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL: Vertebral fractures predict subsequent fractures. Osteoporos Int 1999, 10(3):214-221.
• [13]Middleton E, Gardiner E, Steel S: Which women should be selected for vertebral fracture assessment? comparing different methods of targeting VFA. Calcified Tissue Int 2009, 85(3):203-210.
• [14]Puisto V, Heliövaara M, Impivaara O, Jalanko T, Kröger H, Knekt P, Aromaa A, Rissanen H, Helenius I: Severity of vertebral fracture and risk of hip fracture: a nested case–control study. Osteoporos Int 2011, 22(1):63-68.
• [15]Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV: Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone and Mineral Res 2005, 20(8):1349-1355.
• [16]Kanis JA, Johnell O, Oden A, De Laet C, Mellstrom D: Epidemiology of osteoporosis and fracture in men. Calcified Tissue Int 2004, 75(2):90-99.
• [17]Lewiecki E: Bone densitometry and vertebral fracture assessment. Current Osteoporosis Rep 2010, 8(3):123-130.
• [18]Lofthus CM, Osnes EK, Falch JA, Kaastad TS, Kristiansen IS, Nordsletten L, Stensvold I, Meyer HE: Epidemiology of hip fractures in Oslo, Norway. Bone 2001, 29(5):413-418.
• [19]Lofthus C, Frihagen F, Meyer H, Nordsletten L, Melhuus K, Falch J: Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporos Int 2008, 19(6):781-786.
• [20]Kanis J, Hans D, Cooper C, Baim S, Bilezikian J, Binkley N, Cauley J, Compston J, Dawson-Hughes B, El-Hajj Fuleihan G, et al.: Interpretation and use of FRAX in clinical practice. Osteoporosis Int 2011, 22(9):2395-2411.
• [21]Shin C, Kim M, Shim S, Kim J, Yu S, Koo B, Cho H, Choi H, Cho S, Kim S, et al.: The prevalence and risk factors of vertebral fractures in Korea. Journal of Bone and Mineral Metabolism 2012, 30(2):183-192.
• [22]Fujiwara S, Hamaya E, Goto W, Masunari N, Furukawa K, Fukunaga M, Nakamura T, Miyauchi A, Chen P: Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk in Japan. Bone 2011, 49(3):520-525.
• [23]Waterloo S, Ahmed L, Center J, Eisman J, Morseth B, Nguyen N, Nguyen T, Sogaard A, Emaus N: Prevalence of vertebral fractures in women and men in the population based Tromso study. BMC Musculoskelet Disord 2012, 13(1):3. BioMed Central Full Text
• [24]Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I: Cohort profile: the Tromsø study. Int J Epidemiol 2011.
• [25]El Maghraoui A, Roux C: DXA scanning in clinical practice. QJM 2008, 101(8):605-617.
• [26]Diacinti D, Guglielmi G: Vertebral morphometry. Radiol Clin North Am 2010, 48(3):561-575.
• [27]Grigoryan M, Guermazi A, Roemer F, Delmas P, Genant H: Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 2003, 12:S104-S112.
• [28]Ensrud KE, Schousboe JT: Vertebral Fractures. N Engl J Med 2011, 364(17):1634-1642.
• [29]Omsland TK, Emaus N, Gjesdal CG, Falch JA, Tell GS, Forsen L, Berntsen GK, Meyer HE: In vivo and in vitro comparison of densitometers in the NOREPOS study. J Clin Densitom 2008, 11(2):276-282.
• [30]Woodward M: Epidemiology study design and data analysis . 2nd edition. London: Chapman and Hall; 2005.
• [31]Hanley JA: A heuristic approach to the formulas for population attributable fraction. J Epidemiol Community Health 2001, 55(7):508-514.
• [32]Kanis JA: Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002, 359(9321):1929-1936.
• [33]Donaldson MG, Palermo L, Schousboe JT, Ensrud KE, Hochberg MC, Cummings SR: FRAX and risk of vertebral fractures: the fracture intervention trial. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2009, 24(11):1793-1799.
• [34]Seeman E, Bianchi G, Khosla S, Kanis J, Orwoll E: Bone fragility in men - where are we? Osteoporos Int 2006, 17(11):1577-1583.
• [35]Jones G: Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 1996, 6(3):233-239.
• [36]Orwoll E: Assessing bone density in men. J Bone Miner Res 2000, 15(10):1867-1870.
• [37]Melton LJ III, Orwoll ES, Wasnich RD: Does bone density predict fractures comparably in men and women? Osteoporos Int 2001, 12(9):707-709.
• [38]Pasco J, Henry M, Korn S, Nicholson G, Kotowicz M: Morphometric vertebral fractures of the lower thoracic and lumbar spine, physical function and quality of life in men. Osteoporos Int 2009, 20(5):787-792.
• [39]Clark P, Cons-Molina F, Deleze M, Talavera J, Palermo L, Cummings S: The prevalence of radiographic vertebral fractures in Mexican men. Osteoporos Int 2010, 21(9):1523-1528.
• [40]O'Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ: The prevalence of vertebral deformity in European men and women: the European vertebral osteoporosis study. J Bone Miner Res 1996, 11(7):1010-1018.
• [41]De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, et al.: Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2005, 16(11):1330-1338.
• [42]Dimai HP, Chandran M: Official positions for FRAX(R) clinical regarding smoking from joint official positions development conference of the international society for clinical densitometry and international osteoporosis foundation on FRAX(R). Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry 2011, 14(3):190-193.
• [43]Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, et al.: Interpretation and use of FRAX in clinical practice. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2011, 22(9):2395-2411.