High prevalence of undiagnosed morphometric vertebral fractures in patients with a recent clinical fracture

Abstract

The percentage of patients admitted to the emergency room with a nonspine clinical fracture is over 90%. The prevalence of vertebral fractures in such patients is not well documented. Patients admitted to the hospital with a clinical fracture had fracture and fall risk assessment, BMD in the hip and spine and vertebral morphometry (MXA) usin dual X-ray absorptiometry (DXA). Vertebral fractures were defined according to semiquantitative approach by Genant. We included 712 consecutive and consenting women and men that were able to participate with a mean age of 66 years (range 50-91). Prevalent vertebral fractures (any vertebral height (H) ≤0.80) were found in 51% of the patients (95% confidence interval (CI): 47–55%). Mild fractures (any H=0.76–0.80) were found in 40% of patients, moderate (any H=0.61–0.75) in 29% and severe (any H< 0.60) in 6%. One fracture was present in 21% of the patients, two fractures in 14% and ≥3 in 16%. Fractures with any H≤ 0.80 were found in 58% of patients (CI: 50–65%) with normal BMD,48% (CI: 42–57%) of those with osteopenia and 50% (CI: 43–53%) of those with osteoporosis. Similar values were found in men and women and also if only patients with a fall from standing height had been included. We conclude that nearly one out of two patients with a recent nonspine clinical fracture have undiagnosed morphometric vertebral fractures when measured by MXA, even when BMD is normal. MXA significantly increases the number of patients with the diagnosis of osteoporosis, even when more stringent criteria (any H≤ 0.75) are applied.