Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014

• Published in: Osteoporosis international Vol. 28; no. 6; pp. 1857 - 1866
• Main Authors: Cosman, F., Krege, J. H., Looker, A. C., Schousboe, J. T., Fan, B., Sarafrazi Isfahani, N., Shepherd, J. A., Krohn, K. D., Steiger, P., Wilson, K. E., Genant, H. K.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.06.2017; Springer Nature B.V
• Subjects: Adult; Age; Age Distribution; Aged; Aged, 80 and over; Body mass index; Bone Density - physiology; Bone imaging; Bone mineral density; Clinical decision making; Cross-Sectional Studies; Data processing; Decision making; Endocrinology; Female; Fractures; Humans; Male; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Nutrition Surveys; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - physiopathology; Prevalence; Rheumatology; Risk assessment; Sex Distribution; Spinal Fractures - epidemiology; Spinal Fractures - physiopathology; Spine; United States - epidemiology; Vertebrae; Women; United States > US; Osteoporosis; Screening; Prevalence; Vertebral Fracture Assessment (VFA); Spine fracture
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-017-3948-9

Summary Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them. Introduction Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data. Methods Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013–2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected. Results Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70–79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P  < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA. Conclusion Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.