Who is at greatest risk of developing an osteoporotic vertebral compression fracture

The biggest risk factor for having a vertebral compression fracture is a prior osteoporotic fracture. A person who suffers a vertebral fracture is five times more likely to suffer an additional fracture, when compared with a control with no fracture. Because osteoporosis disproportionately affects older persons, age is a risk factor. In a large cohort of middle-aged individuals studied with serial radiographs over 2 decades, 24% of the women and 10% of the men sustained a vertebral fracture over the course of the study. Interestingly, although the rate of fracture of men and women older than 50 years is not significantly different, the prevalence of females with a fracture is higher due to longer life span.

Loss of bone mass is another risk factor. The relative risk of vertebral fracture is about 2.3 times the risk per standard deviation change in bone mineral density. Obesity is actually protective of bone loss and fracture.

The risk factors for vertebral compression fractures mirror the risk factors for osteoporosis and are classified as modifiable or nonmodifiable:

POTENTIALLY MODIFIABLE RISK FACTORS NONMODIFIABLE RISK FACTORS

• Smoking • Patient history of fracture during adulthood

• Low body weight • History of fracture in a first-degree relative

• Estrogen deficiency (menopause before age 45 years, • Caucasian race bilateral ovariectomy, prolonged premenopausal • Advanced age amenorrhea > 1 year) • Female sex

Alcoholism • Poor health or frailty

• Impaired eyesight despite correction

• Recurrent falls

• Inadequate physical activity

• Poor health or frailty

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