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Bone. 2019 Feb 8;122:14-21. doi: 10.1016/j.bone.2019.02.008. [Epub ahead of print]

High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT.

Author information

1
Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: tove.tveitan.borgen@vestreviken.no.
2
Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.
3
Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
4
Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway.
5
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
6
Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
7
Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
8
Department of Physical Medicine, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
9
Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway.
10
Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
11
Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
12
Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway.
13
Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway.
14
Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway.
15
Department of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
16
Department of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

PURPOSE:

Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures.

METHODS:

This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire.

RESULTS:

Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ -2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%.

CONCLUSIONS:

More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.

KEYWORDS:

Bone mineral density; Fracture risk; Osteoporosis; Trabecular bone score; Vertebral fracture assessment; Vertebral fractures

PMID:
30743015
DOI:
10.1016/j.bone.2019.02.008

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