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Observational Study
. 2024 Dec 31;40(1):50-58.
doi: 10.1093/jbmr/zjae182.

Vertebral fracture prevalence and risk factors for fracture in The Gambia, West Africa: the Gambian Bone and Muscle Ageing Study

Kate A Ward  1   2 , Landing Jarjou  2 , Camille Pearse  1 , Mícheál Ó Breasail  3 , Ramatoulie E Janha  2 , Ayse Zengin  3 , Ann Prentice  2   4 , Nicola J Crabtree  5
Affiliations
Observational Study

Vertebral fracture prevalence and risk factors for fracture in The Gambia, West Africa: the Gambian Bone and Muscle Ageing Study

Kate A Ward et al. J Bone Miner Res. .

Erratum in

Abstract

There are limited data describing the epidemiology of vertebral fractures (VF) from resource-limited settings, where the aging population is growing most rapidly. We aimed to determine the prevalence, incidence, and risk factors for VF in The Gambia, West Africa. The Gambian Bone and Muscle Ageing Study is a prospective observational study in men and women aged 40 yr and over. Rural participants had baseline measurements and plasma samples collected and were followed up 6-8 yr later; urban participants had a single measurement. DXA scans were obtained to assess areal BMD (aBMD), body composition, and VF. Prevalence and incidence were calculated. Risk factors for prevalent and incident fractures were tested using logistic regression, in men and women separately, with and without adjustment for age and BMI. At baseline, 581 individuals (298 women) had useable scans, 214 (127 women) at follow-up. Prevalence of VF was 14.8%. Those with VF were older (65.6(11.2) vs 61.7(12.3) yr, p = .01) and had lower aBMD Z-scores. For example, in women, a 1 SD increase in femoral neck Z-score resulted in a lower risk of having a prevalent VF (OR [95% CI]) 0.51 [0.38, 0.73]. In men, lumbar spine Z-scores were predictive of prevalent fracture (0.71 [0.53, 0.97]). The incidence of VF over follow-up was 12.1%. Low BMD and grip strength were associated with the odds of having an incident VF. Given the importance of prevalent VF in predicting future VF and other fragility fractures in other populations, our findings are a major cause for concern. VF prevalence in Gambian older adults is similar to elsewhere, despite fractures not being a perceived issue. Risk factors were like those identified elsewhere, including age, aBMD, and bone resorption. Understanding the impact of these fractures is important in a region where the health of the aging population needs to be prioritized.

Keywords: DXA; aging; analysis/quantitation of bone; epidemiology; general population studies; osteoporosis.

Plain language summary

The aging population is growing rapidly, and most in low- and middle-income countries, leading to inevitable increases in the occurrence of low trauma fractures. In Africa, we know little about fractures and how often they occur in older people. Fractures of the spine are the most common fragility fracture in older people and lead to further increased risk of fragility fracture. Women and men aged 40 yr and above, living in The Gambia, West Africa, were invited to take part and followed for 6-8 yr. Participants received spine images to determine the prevalence of spinal fractures and completed surveys, physical function and muscle measurements, and blood samples to identify risk factors for prevalent (pre-existing) and incident (new) fractures. Of the 581 individuals with useable baseline scans, the prevalence of vertebral fractures was 15%. Areal BMD and age were the strongest factors associated with VF. Of the 214 participants with longitudinal scans, the incidence of spinal fracture was 12%. The number of spine fractures in Gambian older adults is similar to elsewhere in the world; this is despite fragility fractures not being considered an issue in African adults. Risk factors were like those identified elsewhere. Understanding the impact of these fractures is important in a region where the health of the aging population needs to be prioritized.

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Conflict of interest statement

Authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Frequency distribution of total hip, femoral neck, and lumbar spine T-scores by sex at baseline. Those with VF are in gray and dotted line, mean of non-fracture group are in white, with solid black line.
See this image and copyright information in PMC

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