Male-female disparity in clinical features and significance of mild vertebral fractures in community-dwelling residents aged 50 and over

Abstract

This investigation examined the clinical implications of mild vertebral fractures in older community-dwelling residents. Focusing on the locomotion health of older individuals, the earlier reported Obuse study enrolled 415 randomly sampled Japanese residents aged between 50 and 89 years, 411 of whom underwent X-ray evaluations for pre-existing vertebral fractures. A blinded assessment of vertebral fractures based on Genant's criteria was conducted on the T5-L5 spine for rating on a severity scale. Grade 1 mild fractures were not linked to age in males, but increased with aging in females. Female participants had fewer Grade 1 and 2 fractures (P = 0.003 and 0.035, respectively) but more Grade 3 fractures (P = 0.013) than did males independently of age (Grade 1, 2, and 3: 25%, 16%, and 9% in females and 40%, 22%, and 6% in males, respectively). Weak negative correlations were observed between the number of fractures and bone mineral density in females for all fracture grades (Spearman's rho: 0.23 to 0.36, P < 0.05). Our study showed that Grade 1 mild vertebral fractures in males lacked pathological significance, while in females they potentially indicated fragility fractures and were related to poor lumbopelvic alignment.

Figure 1

Grading of vertebral fractures by a semi-quantitative method.

Figure 2

Prevalence of morphometric vertebral fractures.

Figure 3

Relationship between sagittal spinal alignment and the number of vertebral fractures. The effect values were adjusted for age group. Bands indicate the 95% confidence intervals. SVA sagittal vertical axis, GT global tilt, TK thoracic kyphosis, LL lumbar lordosis, PT pelvic tilt, deg degrees.

Figure 4

Relationship between quality of life and the number of vertebral fractures. The effect values were adjusted for age group. Bands indicate the 95% confidence intervals. PCS physical component summary score, MCS mental component summary score.