Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk factors.
OBJECTIVE
to determine the prevalence of vertebral fractures and their risk factors in geriatric patients.


METHODS
prospective cohort study.


METHODS
teaching hospital in Amsterdam, The Netherlands.


METHODS
three hundred and three geriatric patients, who had their first visit at a diagnostic day hospital between April and August 2007.


METHODS
lateral X-rays of the lumbar spine and chest were performed; vertebral fractures were scored according to the semi-quantitative method of Genant by trained observers and compared with the official report of radiologists. Co-morbidity, reported falls, mobility and cognitive function were scored.


RESULTS
vertebral fractures were observed in 51% (156/303) of geriatric patients. Sixty-nine per cent (107/156) of these fractures were moderate to severe. In 21% (33/156) of the patients with a fracture, vertebral fractures were diagnosed on the lumbar spine X-ray alone. Patients with vertebral fractures had more previous non-vertebral fractures (odds ratio: 2.40 95% CI: 1.40-4.10), had lower serum albumin levels (OR: 0.92 95% CI: 0.87-0.97) and more current prednisone use (OR: 8.94 95% CI: 1.12-71.45). Co-morbidity and cognitive decline were not identified as risk factors. Radiologists reported vertebral fractures in 53% (82/156) of the cases.


CONCLUSIONS
this study showed a very high prevalence of vertebral fractures in geriatric patients; particularly the high prevalence of moderate and severe fractures is remarkable. Because of this high prevalence, the routinely performed lateral X-ray of the chest should be used to look for vertebral fractures. An additional X-ray of the lumbar spine might be useful in patients without vertebral fractures on the chest X-ray.
Department of Geriatrics, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. h.vanderjagt@slz.nl
Hanna C
HC
van der Jagt-Willems
Marike
M
van Hengel
Marijn
M
Vis
Barbara C
BC
van Munster
Jos P C M
JP
van Campen
Linda R
LR
Tulner
Willem F
WF
Lems
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*