Risk of vertebral fractures in osteoporotic women: definition of a clinically relevant scale of risk
Alessandra Fusco1, Enrico Pola2, Marilda Mormando1, Debora Colangelo2, Luigi Aurelio Nasto2, Antonio Bianchi1, Carlo Ambrogio Logroscino2 & Laura De Marinis1
Introduction: Osteoporosis is a disease characterized by a low bone mass and the development of nontraumatic fractures, most commonly in the spine. However, bone mineral density (BMD) alone is not completely satisfactory in vertebral fracture risk assessment.
Aim of the study: To identify clinical and laboratoristic factors associated with an increased risk of vertebral fractures in osteoporotic Caucasian women and to define a new clinically relevant scale of risk.
Materials and methods: Four hundred patients (age: 5587 years) consecutively admitted at our ambulatory for the treatment of post-menopausal osteoporosis were included in the study. The vertebral fractures were diagnosed by Morphometric CT and MRI for each patient.
Results: One hundred and forty-six patients of the entire population presented at least one vertebral fracture for a total of 411 fractures. When considered alone, age (>65 years), lumbar T-score (≤−3.5), lumbar Z-score (≤−2.5), lumbar BMD (≤ 0.800), femoral T-score (≤ −3.5), femoral Z-score (≤ −2.5), L3 volume (≤ −2.0 S.D.) and T7 volume (≤ −2.0 S.D.) were significantly associated with an increased risk of vertebral fractures. Considering only the patients with two fractures or more, the same parameters with the exception of the femoral T-score resulted strongly associated with the risk of new vertebral fractures. Moreover, there was a significantly increased risk of vertebral fractures when two or more of these parameters were present together (P=0.02). On the base of the obtained data we have then defined a new scale of risk (from grade I-low risk in patients without risk factors to grade IV-very high risk in patients with three or more risk factors) confirmed in a prospective study conducted on 60 osteoporotic patients followed for 2 years.
Conclusion: Our findings indicate that clinical and laboratoristic variables may have a synergistic effect on the risk of vertebral fractures.