Fracture risk in men and women with vertebral fractures identified opportunistically on routine computed tomography scans and not treated for osteoporosis: An observational cohort study
Fracture risk in men and women with vertebral fractures identified opportunistically on routine computed tomography scans and not treated for osteoporosis: An observational cohort study
Vertebral fractures (VFs) have been associated with future fractures, yet few studies have evaluated whether this pertains to VFs available for identification on routine radiological imaging. We sought to evaluate the risk of subsequent fractures in subjects with VF identified opportunistically on computed tomography (CT) scans performed as part of routine clinical practice. From the radiology database of Holbæk Hospital we identified the first CT scan including the thorax and/or abdomen of 2000 consecutive men and women aged 50 years or older, performed from January 1, 2010 onward. The scans were assessed in a blinded approach to identify chest and lumbar VF, and these data linked to national Danish registers. Subjects were excluded if treated with an osteoporosis medication (OM) in the year prior to baseline (date of CT), and the remaining subjects with VF matched on age and sex in 1:2 ratio against subjects with no VF. We found that the risk of major osteoporotic fractures (hip, non-cervical vertebral, humerus, and distal forearm fractures) was higher for subjects with VF than without VF: incidence rates (IRs) were 32.88 and 19.59 fractures per 1000 subject-years, respectively, and the adjusted hazard ratio (HR
adj) was 1.72 (95% confidence interval [CI], 1.03–2.86). Subsequent hip fracture IRs were 16.75 and 6.60; HR
adj 3.02 (95% CI, 1.39–6.55). There were no significant differences in other fracture outcomes (including a pooled estimate of any subsequent fracture, except face, skull, and fingers: IRs 41.52 and 31.38; HR
adj 1.31 [95% CI, 0.85–2.03]). Our findings suggest that subjects undergoing routine CT scans including the chest and/or abdomen are a high risk population in terms of fracture risk. Even within this group, subjects with VF are at higher risk of future major osteoporotic fracture (MOF), in particular hip fracture. Hence, systematic opportunistic screening for VF and subsequent fracture risk management is important to reduce the risk of new fractures.
FRACTURE PREVENTION, HEALTH SERVICES RESEARCH, OSTEOPOROSIS, RADIOLOGY, SCREENING
Skjodt, Michael K.
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Nicolaes, Joeri
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Smith, C D
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Olsen, K.R.
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Cooper, Cyrus
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Libanati, Cesar
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Abrahamsen, Bo
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May 2023
Skjodt, Michael K.
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Nicolaes, Joeri
53748c31-2c0f-4eee-b315-cb720403f42c
Smith, C D
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Olsen, K.R.
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Cooper, Cyrus
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Libanati, Cesar
4e3b711d-453b-4f15-b175-3975d566b9c9
Abrahamsen, Bo
ea627e06-482e-479f-8631-5b0f3aec5d13
Skjodt, Michael K., Nicolaes, Joeri, Smith, C D, Olsen, K.R., Cooper, Cyrus, Libanati, Cesar and Abrahamsen, Bo
(2023)
Fracture risk in men and women with vertebral fractures identified opportunistically on routine computed tomography scans and not treated for osteoporosis: An observational cohort study.
JBMR Plus, 7 (5), [e10736].
(doi:10.1002/jbm4.10736).
Abstract
Vertebral fractures (VFs) have been associated with future fractures, yet few studies have evaluated whether this pertains to VFs available for identification on routine radiological imaging. We sought to evaluate the risk of subsequent fractures in subjects with VF identified opportunistically on computed tomography (CT) scans performed as part of routine clinical practice. From the radiology database of Holbæk Hospital we identified the first CT scan including the thorax and/or abdomen of 2000 consecutive men and women aged 50 years or older, performed from January 1, 2010 onward. The scans were assessed in a blinded approach to identify chest and lumbar VF, and these data linked to national Danish registers. Subjects were excluded if treated with an osteoporosis medication (OM) in the year prior to baseline (date of CT), and the remaining subjects with VF matched on age and sex in 1:2 ratio against subjects with no VF. We found that the risk of major osteoporotic fractures (hip, non-cervical vertebral, humerus, and distal forearm fractures) was higher for subjects with VF than without VF: incidence rates (IRs) were 32.88 and 19.59 fractures per 1000 subject-years, respectively, and the adjusted hazard ratio (HR
adj) was 1.72 (95% confidence interval [CI], 1.03–2.86). Subsequent hip fracture IRs were 16.75 and 6.60; HR
adj 3.02 (95% CI, 1.39–6.55). There were no significant differences in other fracture outcomes (including a pooled estimate of any subsequent fracture, except face, skull, and fingers: IRs 41.52 and 31.38; HR
adj 1.31 [95% CI, 0.85–2.03]). Our findings suggest that subjects undergoing routine CT scans including the chest and/or abdomen are a high risk population in terms of fracture risk. Even within this group, subjects with VF are at higher risk of future major osteoporotic fracture (MOF), in particular hip fracture. Hence, systematic opportunistic screening for VF and subsequent fracture risk management is important to reduce the risk of new fractures.
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JBMR Plus - 2023 - Skj dt - Fracture Risk in Men and Women With Vertebral Fractures Identified Opportunistically on Routine
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Accepted/In Press date: 14 February 2023
e-pub ahead of print date: 16 February 2023
Published date: May 2023
Additional Information:
Funding Information:
Thank you to Sören Möller (OPEN—Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark) for statistical support, and Preben Trunshøj (independent) for assistance in the acquisition of the CT scans from the Holbæk Hospital radiology database. This is an investigator initiated study funded by a grant from the Region Zealand Health Scientific Research Foundation, and by a collaborator grant from UCB Pharma/Amgen Inc. The lead author was supported by a PhD scholarship from the Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. CL and JN are UCB Pharma employees, and the manuscript was shared with UCB Pharma/Amgen Inc. for courtesy review prior to submission. The other funders were not involved in the study.
Funding Information:
Thank you to Sören Möller (OPEN—Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark) for statistical support, and Preben Trunshøj (independent) for assistance in the acquisition of the CT scans from the Holbæk Hospital radiology database. This is an investigator initiated study funded by a grant from the Region Zealand Health Scientific Research Foundation, and by a collaborator grant from UCB Pharma/Amgen Inc. The lead author was supported by a PhD scholarship from the Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. CL and JN are UCB Pharma employees, and the manuscript was shared with UCB Pharma/Amgen Inc. for courtesy review prior to submission. The other funders were not involved in the study.
Publisher Copyright:
© 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Keywords:
FRACTURE PREVENTION, HEALTH SERVICES RESEARCH, OSTEOPOROSIS, RADIOLOGY, SCREENING
Identifiers
Local EPrints ID: 476837
URI: http://eprints.soton.ac.uk/id/eprint/476837
ISSN: 2473-4039
PURE UUID: 40399641-449e-4b26-8175-f0c551bebeaa
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Date deposited: 17 May 2023 16:44
Last modified: 18 Mar 2024 02:47
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Contributors
Author:
Michael K. Skjodt
Author:
Joeri Nicolaes
Author:
C D Smith
Author:
K.R. Olsen
Author:
Cesar Libanati
Author:
Bo Abrahamsen
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