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. 2024 Nov 29;39(12):1744-1751.
doi: 10.1093/jbmr/zjae172.

Association of vertebral fractures with worsening degenerative changes of the spine: a longitudinal study

Carrie Ye  1   2 , William D Leslie  3 , Mary L Bouxsein  4 , Alyssa B Dufour  5   6 , Ali Guermazi  7 , Daniel Habtemariam  5 , Mohamed Jarraya  8 , Douglas P Kiel  5   6 , Pradeep Suri  9   10   11 , Elizabeth J Samelson  5   6
Affiliations

Association of vertebral fractures with worsening degenerative changes of the spine: a longitudinal study

Carrie Ye et al. J Bone Miner Res. .

Abstract

Vertebral compression fractures (VFs) and spinal degeneration are both common causes of back pain, particularly in older adults. Previous cross-sectional studies have shown a potential association between these entities, but there is limited evidence on the role of VFs in spinal degeneration. In this longitudinal study, we evaluated the association between prevalent VFs and the subsequent progression of facet joint osteoarthritis (FJOA) and intervertebral disc height narrowing (DHN), using data from the Framingham Heart Study Offspring and Third Generation Multi-Detector Computed Tomography study. Summary indices representing the total burden of each spinal parameter (VFs, DHN, and FJOA) were calculated for each individual. We hypothesized that prevalent VFs are associated with worsening spinal degeneration. Three hundred and seventy (31%) of 1197 participants had a baseline (prevalent) VF. The change in summary index of DHN over the follow-up period was significantly higher in those with vs without prevalent VF (difference in change in DHN 0.38, 95% CI 0.18 to 0.59, p<.001), but the change in summary index of FJOA was similar between those with and without prevalent VF. However, once adjusted for age, sex, cohort, smoking status, BMI, and baseline DHN, the change in summary index of DHN did not differ by prevalent VF status. There was a modestly higher change in the FJOA summary index in those with prevalent VFs compared to those without in the fully adjusted model (difference in change in FJOA 0.62, 95% CI -0.01 to 1.24, p = .054), driven primarily by those with severe (grade 3) VF (difference in change in FJOA 4.48, 95% CI 1.99-6.97). Moreover, there was greater change in the summary index of FJOA with increasing severity of prevalent VF (linear trend p = .005). Beyond the established morbidity and mortality associated with VFs, our study suggests that VFs may also lead to worsening spine osteoarthritis.

Keywords: general population studies < epidemiology; osteoarthritis < diseases and disorders of/related to bone; osteoporosis < diseases and disorders of/related to bone; other < analysis/quantitation of bone; radiology.

Plain language summary

Vertebral compression fractures and spinal degeneration are both common causes of back pain. Previous studies have shown a potential link between these two entities, but it is not clear if one leads to the other. In this study, we examined the relationship between vertebral compression fractures and future progression of spinal degeneration. In this study of 1197 participants, those who had a vertebral compression fracture at the start of the study developed more spinal degeneration over 6 yr of follow-up. There was an association between higher number and/or severity of vertebral compression fractures at the start of the study and worse spinal degeneration over the follow-up period. This study shows that vertebral compression fractures may lead to worsening spinal degeneration.

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Conflict of interest statement

CY, WDL, EJS, PS, DK, MJ, ABD, MLB, DH have no conflicts of interest to disclose. AG is consultant to Pfizer, TissueGene, Novartis, Coval, Medipost, ICM and Formation Bio and is a shareholder of BICL, LLC.

Figures

Figure 1
Figure 1
Prevalent VF and worsening DHN and FJOA over 6 years, by vertebral level. Worsening DHN and FJOA was defined as an increase of at least 1 unit of SQ score at the vertebral level from baseline to follow-up. Abbreviations: VF = vertebral fracture; DHN = disc height narrowing; FJOA = facet joint osteoarthritis.
See this image and copyright information in PMC

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