Mortality in the presence of a vertebral fracture, scoliosis, or Scheuermann's disease in the thoracic spine.
OBJECTIVE
Vertebral fractures and scoliosis, unlike Scheuermann's disease, have been associated with increased mortality. Total and cause-specific mortalities of these spinal deformities were studied to produce epidemiologic knowledge.


METHODS
A population of 16,010 Finnish men and women 20 to 92 years of age participated in a health examination from 1973-1976. Their spinal deformities were assessed from chest radiographs by two radiologists. Logistic regression and Cox's model were used to estimate risk ratios and to control confounding. The follow-up period was 30 years.


RESULTS
Vertebral fracture significantly predicted total mortality, and this increase in mortality was due to an excess of cancer and respiratory deaths. The increased risk of cancer death persisted even when those subjects with a history of cancer and the first 5 years of follow-up were excluded to avoid the effect of metastatic fractures, and when confounding was controlled. In this analysis the relative risk of cancer death in subjects with a baseline vertebral fracture was 2.02 (95% confidence interval: 1.23-3.31).


CONCLUSIONS
Vertebral fracture significantly predicted increased mortality from cancer. To clarify the mechanism, the fractures should be studied further for their associations with defined and site-specific cancer types.
Puisto
Ville
V
National Public Health Institute and the Hospital for Children and Adolescents, Helsinki, Finland. ville.puisto@helsinki.fi
Rissanen
Harri
H
Heliövaara
Markku
M
Knekt
Paul
P
Helenius
Ilkka
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D013902:Radiography, Thoracic; D012140:Respiratory Tract Diseases / Q000401:mortality; D012544:Scheuermann Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000401:mortality*; D017678:Sex Distribution; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000401:mortality*