Finnish study finds severe vertebral fractures predict eventual hip fractures

Ville Puisto

VIENNA — A vertebral fracture that substantially reduces vertebral body height should alert orthopaedic surgeons to a patient at risk for a subsequent hip fracture, according to results of a Finnish population-based study.

The two types of fractures, which may be related to osteoporosis, especially when they occur in elderly individuals, frequently present in tandem. Therefore, “The aim of our study was to evaluate how the severity of vertebral compression fractures (VCFs) affects the risk of subsequent hip fractures,” Ville Puisto, MD, said at the 2010 Annual Congress of the Spine Society of Europe (EuroSpine 2010), here.

‘Best in Show’ paper

Puisto and orthopedic colleagues at Helsinki University Central Hospital conducted a nested case-controlled study into the possible relationship between the two types of fractures. The study was among the “Best of Show” papers presented the final morning of the meeting.

For their data, investigators used the Mini-Finland Health Survey done 1978 to 1980 involving 7,095 men and women age 30 years and older, and the chest radiographs all participants had as part of the survey. They used Finland’s National Hospital Discharge Register to identify which survey participants were hospitalized through the end of 1994 for a primary hip fracture.

The surveyed group sustained 169 hip fractures. Investigators then matched them each with three controls within the same original cohort by age, gender and place of residency and studied their chest X-rays to identify baseline VCFs (T3-T12). They used Genant’s numeric classification of VCFs as mild to severe to characterize the spine fractures.

Predictive value

Based on fracture grades, severe VCFs strongly predicted hip fractures, according to Puisto, however milder VCFs were less of a predictor of hip fracture relative risk.

When investigators controlled for factors that might affect the outcomes, ranging from amount of physical activity to smoking status, they found the relative odds of a hip fracture was 12.06 following a severe VCF.

“We recommend the clinical evaluation of these high risk patients and offer them prevention for falls and treatment for osteoporosis,” Puisto said.

Reference:

Puisto V, Heliovaara M, Impivaara O, et al. Severity of vertebral fracture and risk of hip fracture: A nested case-control study. Paper #60. Presented at EuroSpine 2010. Sept. 15-17, 2010. Vienna.

This is a very nice study. It is nice to see population data used in this way. The strongest finding to come out of the research is the emphasis on the need to evaluate bone mineral density as an indicator of osteoporosis risk.

– Frances MK. Williams, PhD, FRCP(Edin)
Head of the Twin Research and Genetic Epidemiology Unit
King’s College, London

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