Bone Abstracts

Incidence of vertebral fractures in the EU has been estimated in 520 000 for the year 2010. Clinical vertebral fractures cause most of the impact in terms of morbidity, quality of life and economic burden. However, even the sub-clinical ones are not neutral in these aspects. Unlike hip fractures, their incidence is less dissimilar across Europe. Mortality in the first year after a vertebral fracture is higher than for hip fracture, especially in the younger age groups. Vertebral fractures have been linked to 6000 deaths/year in women and 8000 in men, directly attributable to fracture in the EU27. This risk is clearly increased in individuals with three or more fractures.

Reasons for mortality are not fully elucidated. Vertebral fracture can be a marker of poor health and, therefore, comorbidities have been invoked as the reason for decreased survival. As a consequence, mortality studies may have significant bias.

Besides the widely known effects on pain and quality of life, VFx have been associated with decreased pulmonary function. Frailty syndrome may be a common driver for VFx and death. Increased cardiovascular risk is associated to osteoporotic fractures and stroke occurs at a increased rate after a VFx. Paradoxically, obese individuals show reduced mortality risk. In any event, a residual mortality effect of VFx seems to remain after adjusting by comorbidities and other prognostic factors.

Efficacy of interventions to reduce mortality after VFx is not fully assessed. Use of bisphosphonates and SERMs decrease overall mortality but no direct attribution to decreased fracture incidence can be drawn for most of the effect. Kypohplasty (not vertebroplasty) has been associated with a 35% decrease in mortality and a median life expectancy increase of 3.0–9.5 years.

Vertebral fractures are under diagnosed. Presence of fractured vertebrae in lateral chest X-ray films is systematically ignored. Back pain may indicate the presence of VFx but, with little doubt, kyphosis developed during late life and height loss must alert the clinician. Treating spinal osteoporosis is obliged to decrease the impact of VFx in pain, quality of life and, eventually, in decreased life expectancy.