Prevalence of vertebral fracture ‘very high’ among elderly patients
MedWire News: Vertebral fractures are extremely common in geriatric patients, say Dutch researchers, who suggest that chest X-rays on elderly patients should be routinely checked for spinal fractures.
Hanna van der Jagt-Willems (Slotervaart Hospital, Amsterdam, the Netherlands) and team explored the prevalence of vertebral fractures and their risk factors in a cohort of geriatric patients.
They studied 303 consecutive patients who were attending a geriatric outpatient clinic for the first time. The reasons for referral included memory complaints, weight loss, falls, and polypharmacy. All patients underwent a thorough workup including chest and lumbar spinal radiographs.
Reporting their findings in Age and Ageing, the authors state that patients' mean age was 82 years and 63% were female. Patients had an average of two chronic diseases each and 18% were known to have osteoporosis. Mobility was poor, with 51% having suffered a fall in the last year, and 47% had impaired cognition.
The overall prevalence of vertebral fractures was 51%, van der Jagt-Willems et al reveal.
Patients had 2.1 vertebral fractures each, on average, with 47% of patients having one fracture, 26% having two, and 27% of patients having more than two. To the authors' surprise, the severity of fractures was evenly spread among the mild, moderate, and severe categories.
In multivariate analysis, three factors independently predicted vertebral fractures: a history of nonvertebral fractures (odds ratio [OR]=2.40), prednisone use (OR=8.94), and low serum albumin (OR=0.92).
"Our hypothesis that patients with vertebral fractures would have a higher comorbidity was not confirmed," the authors admit.
Additionally, they note that 33 patients (11%) had a vertebral fracture in the lumbar spine at L2 or lower, which would not have appeared on a chest X-ray. Thus, patients with no vertebral fracture on chest X-ray have around an 18% chance of having a lumbar fracture.
Finally, geriatricians correctly diagnosed vertebral fractures in 70% of cases, while radiologists diagnosed just 53% of fractures.
The researchers conclude that there is a "very high" prevalence of vertebral fractures, including moderate and severe fractures, among elderly patients attending a diagnostic day clinic.
"An additional lumbar spine X-ray might be recommended for patients without a vertebral fracture on the chest X-ray, since patients with a lumbar spine fracture cannot be diagnosed through clinical characteristics," they write.
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By Joanna Lyford