Radiology alliance for health services researchRAHSR symposium: Evidence-based radiology: Lessons learned from vertebroplasty researchEpidemiology of Vertebral Fractures: Implications for Vertebral Augmentation1
Section snippets
Frequency of vertebral fractures
The first issue that must be addressed is: What constitutes a vertebral fracture? This is problematic because vertebral “deformities” are equated with vertebral “fractures,” yet there is no consistent relation between back pain and changes in vertebral shape on radiographs (1). Thus it has not been possible to unequivocally distinguish fractures from other vertebral body abnormalities. This is a particularly difficult problem in epidemiologic studies, in which subjects are assessed in the
Risk factors for vertebral fractures
Some vertebral fractures that present for vertebral augmentation result from severe trauma or lytic bone lesions. However, specific pathologies and severe trauma account for just 3% and 14%, respectively, of all clinically evident vertebral fractures in the community (13). The vast majority of vertebral fractures, including those treated with vertebral augmentation, in North America are related instead to osteoporosis. Thus the effects of age, sex, and race on vertebral fracture risk are
Natural history of vertebral fractures
The most potent risk factor for fracture is a history of a previous fracture. One meta-analysis concluded that the occurrence of a vertebral fracture increases the risk of another one at least fourfold among postmenopausal white women, with an even greater excess among other patient populations (38). This estimate is supported by placebo results from the FIT and Multiple Outcomes of Raloxifene (MORE) trials where the risk of a new vertebral fracture was about four times higher in the women who
Outcomes of vertebral fractures
Optimal management of vertebral fractures is essential because they are so common and so often linked with adverse outcomes. Thus the lifetime risk of a clinically evident vertebral fracture among postmenopausal white women from age 50 years onward has been estimated at about 16%; the lifetime risk in white men is only about 5% because their vertebral fracture incidence rates are somewhat lower and their life expectancy is considerably less than that in women (49). Although complete (ie,
Conclusion
Although there are opportunities for primary prevention of vertebral fractures (eg, by diagnosing and treating osteoporosis), much of the disease burden noted above results from recurrent vertebral fractures. However, these are also preventable to a significant degree by medical therapies (eg, bisphosphonates, selective estrogen receptor modulators) as demonstrated by a number of large, randomized, controlled clinical trials (27). Any contribution of vertebral augmentation to fracture
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Supported in part by research grants AG04875, AR27065, and AR30582 from the National Institutes of Health, U.S. Public Health Service.