Risk factors for incident vertebral fractures in men and women: the Rotterdam Study
Open accessAbstract
Low BMD and prevalent vertebral fractures are known risk factors for incident vertebral fractures. In 3001 men and women from the Rotterdam Study, prevalent nonvertebral fractures, early menopause, current smoking, and walking aid use were also strong risk factors for incident vertebral fractures. Introduction: Thus far, age, low BMD, and prevalent vertebral fractures are the only well-known risk factors for incident vertebral fractures. Therefore, our aim was to investigate other potential risk factors for incident vertebral fractures in the elderly. Materials and Methods: This study was based on the Rotterdam Study, a large prospective population-based cohort study among men and women ≥55 years of age. For 3001 subjects, spinal radiographs were obtained at baseline and again ∼6.3 years later. These follow-up radiographs were scored for vertebral fractures using the McCloskey-Kanis method. Whenever a vertebral fracture was detected, the radiograph was compared with the baseline radiograph. If this fracture was not already present at baseline, it was considered incident. At baseline, information on potential risk factors was obtained. Results: Low BMD and prevalent vertebral fractures were strong risk factors for incident vertebral fractures in both men and women (RR 2.3 [1.6-3.3] and 2.2 [0.9-5.0] for men and RR 2.1 [1.6-2.6] and 4.1 [2.5-6.7] for women, respectively). For women, age, early menopause (≤45 years of age; RR 1.0 [1.1-3.5]), current smoking (2.1 [1.2-3.5]), and walking aid use (2.5 [1.1-5.5]) were additional independent risk factors. For men, only a history of nonvertebral fractures was a significant independent risk factor (OR 2.4 [1.2-4.8]). Conclusion: Apart from low BMD and prevalent vertebral fractures, prevalent nonvertebral fractures are associated with an increased incident vertebral fracture risk in men. In women, early menopause, current smoking, and walking aid use are additional independent risk factors for incident vertebral fractures.
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Increased bone mass occurs after 12 months, and fracture development is slowed in patients with no previous osteoporosis.
“Increased bone mass occurs after 12 months (173), and fracture development is slowed in patients with no previous osteoporosis (159).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [159]
The Unadjusted analyses (p. 4) show fewer incident vertebral fractures among participants with no vertebral fracture at baseline than among those with a prior vertebral fracture. The paper does not establish that these participants had no previous osteoporosis or that fracture development was slowed; it reports an association with fracture history, not a change in the rate of development. (LLM, conf=0.78)
Experimental — accuracy not yet measuredOther pituitary hormone deficits and/or their treatment also affect bone mineral density and the risk of fracture in central hypogonadism.
“Other pituitary hormone deficits and/or their treatment also affect BMD and the risk of fracture in central hypogonadism (131,159,160).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [159]
The Results (p. 1) link low BMD with incident vertebral fractures, and the Discussion (p. 6) discusses estrogen exposure and menopause. Neither addresses whether other pituitary hormone deficits or their treatment affect BMD or fracture risk in central hypogonadism; searches for pituitary deficits, central hypogonadism, and hormone replacement found no such passage. (LLM, conf=0.76)
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References 42 · Cited by 197
- Authors
- van der Klift, M., de Laet, C. E., McCloskey, E. V., Johnell, O., Kanis, J. A., Hofman, A., & Pols, H. A.
- Affiliations
- Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus Medical Centre, Rotterdam, The Netherlands
- University of Sheffield (GB)
- Department of Orthopaedics, Malmö General Hospital, Malmö, Sweden
- World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
- Erasmus MC (NL)
- Corresponding author
- Pols, Huibert AP
- ORCID
- McCloskey, Eugene V
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-07-01
- Volume
- 19
- Issue
- 7
- Pages
- 1172-1180
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W2023323669
- Semantic Scholar
- 534f88c0284cd29a85125e166003a7b62944c928
- Cited by
- 197
- References
- 42
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 10 · 2018: 8 · 2017: 9 · 2016: 8 · 2015: 12 · 2014: 7 · 2013: 9 · 2012: 14
- FWCI
- 10.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Keywords
- vertebral fractures, incident fractures, risk factors, bone mineral density, non-vertebral fractures, early menopause, smoking, walking aids, older adults, sex differences, osteoporosis
- MeSH terms
- Aged, Aged, 80 and over, Female, Fractures, Spontaneous, Humans, Male, Middle Aged, Radiography, Risk Factors, Spine, Cohort Studies, Bone Density, Incidence, Spinal Fractures
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