Background/Purpose: Vertebral fractures are associated with increased future fracture risk and mortality. No data on incidence of osteoporotic vertebral fracture have been reported in low-income countries where the population’s aging has been faster. Thus, we sought to describe the incidence and predictors of radiographic vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort – the São Paulo Ageing & Health (SPAH) Study.

Methods: From 2005-2007, all residents ≥65 years living in the Butantã community, located in the Western part of the city of São Paulo, were identified through census records. In total, 1025 subjects were included in the fracture prevalence study. Until 2012, 132 individuals had died during follow-up, and 725 subjects agreed to take part in this longitudinal evaluation (response rate in surviving subjects, 81.2%). Eighteen subjects were excluded due to cancer; thus, 449 women and 258 men were evaluated.  A new vertebral fracture was considered as a distinct alteration in morphology of vertebrae resulting in higher grade of deformity when the second radiograph was compared to the same vertebra on the baseline radiograph. Clinical questionnaire, bone mineral density (BMD) and laboratorial tests were performed at baseline. Multivariate Poisson regression models were used to identify independent predictors of vertebral fracture. 

Results: After a mean follow-up of 4.3±0.8 years, the age-standardized incidence of vertebral fracture was 40.3/1000 person-years in women and 30.6/1000 in men. In women, three possible models of risk factors for fracture were fitted:1. age (RR:2.46, 95%CI 1.66-3.65), previous osteoporotic fracture (RR: 1.65, 95% CI 1.00-2.71) and lumbar spine BMD (RR: 1.21, 95% CI 1.03-1.41); 2. age (RR: 2.25, 95%CI 1.52-3.34) and femoral neck BMD (RR: 1.42, 95% CI 1.11-1.81); 3. age (RR: 2.11, 95% CI 1.41-3.15) and total hip BMD (RR: 1.56, 95% CI 1.21-2.0). In men, the highest quartile of serum type I collagen C-telopeptide (CTX) (RR: 1.96, 95% CI 0.98-3.91) and prior fracture (RR: 2.10, 95% CI 1.00-4.39) were predictors of new vertebral fracture.

Conclusion: This is the first population-based study to ascertain the incidence of vertebral fracture in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, BMD and bone turnover were predictors of the short-term incidence of vertebral fracture.

 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-and-risk-factors-for-osteoporotic-vertebral-fracture-in-low-income-community-dwelling-elderly-a-population-based-prospective-cohort-study-in-brazil-the-sao-paulo-ageing-health-spah/