Background/Purpose: The presence of non-traumatic vertebral fracture can identify a patient who has clinical osteoporosis. However, approximately 75% of vertebral fractures are asymptomatic and as many as 45% of vertebral fractures in North America go unrecognized. As a result, a significant number of cases of osteoporosis are missed and left untreated, leaving patients vulnerable to future fractures and morbidity and contributing to the economic burden of osteoporosis related fractures in the United States. We investigated whether women with 2 or more inches of height loss have a high incidence of fractures, whether the degree of height loss correlates with presence of fractures, and how these findings correlate with bone density, in order to test whether height loss could be a potential screening tool for osteoporosis. Additionally, we assessed how many of these patients with 2 or more inches of height loss had been treated for osteoporosis in the past.

Methods: From among all postmenopausal female patients seen at our academic Osteoporosis Center, we prospectively enrolled a cohort of 100 subjects self-reporting two or more inches of height loss from maximum height. Enrollment occurred over a two-year period. Patients with a history of spinal surgery or significant scoliosis (>10% spinal curvature) were excluded. At intake, all patients had radiographs of the lumbar and thoracic spine (AP and lateral). A vertebral fracture was defined as >20% vertebral height loss based on the guidelines from the Vertebral Fracture Initiative by the International Osteoporosis Foundation. Intervertebral disc disease was classified based on the Genant modification of the Sharp method.

Results: Of 100 patients with height loss, 76 had a fracture of the thoracic or lumbar spine, or both. 58 women had fractures of their thoracic spine and 50 of their lumbar spine. Among the 76 women with a diagnosis of fracture, 21 (28%) had never been treated for osteoporosis. Among the 24 patients without fractures, the average T-Score was -2.0 of the spine. Among all the patients, 96 had intervertebral disc disease (94 had thoracic and 75 had lumbar disc disease). When evaluating the degree of height loss in all of the patients, there was no significant difference between the patients who had sustained a fracture and those who had not.

Conclusion: In this study, 2 or more inches of height loss was explained by vertebral fracture and presence of disc disease, or both, with the majority of subjects demonstrating fractures pathognomonic for osteoporosis. Individuals with 2 or more inches of height loss and no fractures had T scores mainly in the osteopenic-osteoporotic range. Our data therefore suggest that any patient with 2 or more inches of height loss should be evaluated for both vertebral fractures and osteoporosis. Significantly, 28% of women with radiographic findings of compression fracture had not previously been treated for osteoporosis, underlining the need for better screening and treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/presence-of-vertebral-fractures-and-disc-disease-in-post-menopausal-females-with-height-loss-as-a-possible-screening-method-for-osteoporosis/