Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk factors

• Published in: Age and ageing 2012-03, Vol.41 (2), p.200-206
• Main Authors: van der Jagt-Willems, Hanna C., van Hengel, Marike, Vis, Marijn, van Munster, Barbara C., van Campen, Jos P. C. M., Tulner, Linda R., Lems, Willem F.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged patients; Aged, 80 and over; Aging; Chest; Chi-Square Distribution; Diagnosis; Elderly patients; Elderly people; Female; Fractures; Fractures (Injuries); Geriatrics; Geriatrics - statistics & numerical data; Health risk assessment; Hospitals, Teaching - statistics & numerical data; Humans; Injuries; Logistic Models; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Male; Medical examination; Methods; Multivariate Analysis; Netherlands - epidemiology; Odds Ratio; Older people; Outpatient Clinics, Hospital - statistics & numerical data; Prevalence; Prospective Studies; Radiography; Risk Assessment; Risk Factors; Severity of Illness Index; Spinal Fractures - diagnostic imaging; Spinal Fractures - epidemiology; X-rays
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afr174

Objectives: to determine the prevalence of vertebral fractures and their risk factors in geriatric patients. Design: prospective cohort study. Setting: teaching hospital in Amsterdam, The Netherlands. Subjects: three hundred and three geriatric patients, who had their first visit at a diagnostic day hospital between April and August 2007. Measurements: lateral X-rays of the lumbar spine and chest were performed; vertebral fractures were scored according to the semi-quantitative method of Genant by trained observers and compared with the official report of radiologists. Co-morbidity, reported falls, mobility and cognitive function were scored. Results: vertebral fractures were observed in 51% (156/303) of geriatric patients. Sixty-nine per cent (107/156) of these fractures were moderate to severe. In 21% (33/156) of the patients with a fracture, vertebral fractures were diagnosed on the lumbar spine X-ray alone. Patients with vertebral fractures had more previous non-vertebral fractures (odds ratio: 2.40 95% CI: 1.40-4.10), had lower serum albumin levels (OR: 0.92 95% CI: 0.87-0.97) and more current prednisone use (OR: 8.94 95% CI: 1.12-71.45). Co-morbidity and cognitive decline were not identified as risk factors. Radiologists reported vertebral fractures in 53% (82/156) of the cases. Conclusion: this study showed a very high prevalence of vertebral fractures in geriatric patients; particularly the high prevalence of moderate and severe fractures is remarkable. Because of this high prevalence, the routinely performed lateral X-ray of the chest should be used to look for vertebral fractures. An additional X-ray of the lumbar spine might be useful in patients without vertebral fractures on the chest X-ray.