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. 2017 Jun;28(6):1857-1866.
doi: 10.1007/s00198-017-3948-9. Epub 2017 Feb 7.

Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014

F Cosman  1   2 , J H Krege  3 , A C Looker  4 , J T Schousboe  5 , B Fan  6 , N Sarafrazi Isfahani  4 , J A Shepherd  6 , K D Krohn  3 , P Steiger  7 , K E Wilson  8 , H K Genant  6
Affiliations

Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014

F Cosman et al. Osteoporos Int. 2017 Jun.

Abstract

Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them.

Introduction: Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data.

Methods: Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013-2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected.

Results: Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA.

Conclusion: Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.

Keywords: Osteoporosis; Prevalence; Screening; Spine fracture; Vertebral Fracture Assessment (VFA).

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Figures

Figure 1.
Figure 1.
Distribution of fractures at individual vertebra by sex, NHANES 2013-14 VFA fracture sample (n = 186)* The distribution of fractures at each level from T4 through L4 is shown for the 186 subjects found to have one or more vertebral fractures. Results are presented as frequency of fracture at each vertebral level. Note the precision of this information may be low at some levels, and these data are provided to illustrate distribution rather than exact prevalence at each level. As an additional caveat, visualization of T4-T6 was inadequate in some subjects, although only a small proportion of vertebral fractures occur at these levels. *Note: Results are presented as frequency of fracture at each vertebral level
See this image and copyright information in PMC

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