Prevalence of Osteoporotic Vertebral Fracture Among Community-Dwelling Elderly in Shanghai
Osteoporosis is a growing global health concern, leading to over nine million fractures annually. Among these, vertebral fractures are the most common and pose significant risks, including increased morbidity, mortality, and the likelihood of subsequent fractures. Despite the global burden, the descriptive epidemiology and risk factors for vertebral fractures in China remain poorly understood. This study aims to fill this gap by examining the prevalence and characteristics of osteoporotic vertebral fractures among community-dwelling elderly in Shanghai.
The study was conducted as part of the Shanghai Community-dwelling Elderly Health Examination (SCEHE) from 2014 to 2016. A total of 14,075 participants, including 6,313 males aged 60–97 years and 7,762 females aged 60–98 years, were recruited from six communities across Shanghai: Fenglin, Lingyun, Longhua, Qixian, Sanlin, and Xujiahui. Participants were contacted by community staff to attend physical examinations, which did not initially include X-ray imaging of the thoracic and lumbar spine (T4-L4). However, those willing to undergo X-ray imaging were informed of the associated risks and provided consent. Participants also provided information on their characteristics, chronic disease history, and, for females, age at menopause. Lateral thoracolumbar (T4-L4) X-ray radiography was performed, and all radiographs and medical history information were collected at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. The semi-quantitative system by Genant et al. was used to grade vertebral deformities, with all radiographs analyzed by the same experienced radiologist within three months.
Basic demographic and anthropometric data, including age, height, weight, and body mass index (BMI), were collected. For females, years since menopause (YSM) were defined as the time since menopause began, with at least one year since its onset. Radiographs were taken at the respective Community Health Service Centers (CHSCs) using a standardized protocol. Participants were positioned in the left lateral position, with the X-ray centered at T10. Only one radiograph of the thoracic and lumbar spine was taken per participant to limit radiation exposure and due to workforce and financial constraints. The radiographs covered T10-L2 in 99% of cases, T8-L3 in over 95%, and T6-L4 in over 92%. All X-ray images were stored and analyzed at the hospital, where an experienced professor used semi-quantitative techniques to categorize participants into fractured and non-fractured groups.
The study collected fasting blood samples for routine blood examinations, hepatic function, renal function, serum lipids, and fasting blood glucose. Measurements were taken at each CHSC clinical lab using different biochemistry systems, allowing only qualitative comparisons for disease diagnosis rather than quantitative analysis. Eleven characteristics of all participants were collected: age, BMI, YSM for females, and disease history, including hypertension, diabetes, coronary heart disease, stroke, hyperlipidemia, chronic liver disease, chronic kidney disease, and malignant tumor. Statistical analysis was performed using SPSS 19.0, with deformities graded as mild (grade 1, G1), moderate (grade 2, G2), or severe (grade 3, G3). Deformities graded as G1 or higher were considered fractures. Characteristics of fractured participants were compared with non-fractured participants within the same sex using t-tests for continuous variables and Chi-squared analysis for categorical data. Statistical significance was set at P < 0.05.
The study successfully collected 14,075 X-ray images and 9,239 disease histories. Participants were stratified into age groups with five-year intervals and divided into fractured and non-fractured cohorts. Basic anthropometric data and chronic disease history were summarized, and the characteristics of the two cohorts were compared. Male fractured participants were older (72.1 vs. 71.2 years, P < 0.001), shorter (165.2 vs. 166.3 cm, P < 0.001), and weighed less (66.5 vs. 67.4 kg, P = 0.002) than non-fractured males. The fractured cohort had a lower rate of diabetes (12.8 vs. 16.5%, P = 0.025) and a higher rate of stroke (5.5 vs. 3.7%, P = 0.034). Similarly, female fractured participants were older (74.2 vs. 70.9 years, P < 0.001), shorter (152.2 vs. 154.5 cm, P < 0.001), and weighed less (56.5 vs. 57.9 kg, P < 0.001), with a higher rate of hypertension (41.2 vs. 37.5%, P = 0.011) than non-fractured females.
The prevalence of vertebral fracture was 17.2% (2,414/14,075) among all participants, with 17.0% (1,073/6,313) in males and 17.3% (1,341/7,762) in females. The prevalence increased with age in females but remained relatively stable in males. Males had a significantly higher prevalence than females in the 60–64 and 65–69 age groups (P < 0.001 and P = 0.003, respectively), while females had a higher prevalence in the 75–79, 80–84, and over 85 age groups (P = 0.041, P < 0.001, and P = 0.002, respectively). The prevalence of G2 and G3 fractures was significantly higher in females than males across all age groups (P < 0.001), except for the 60–64 age group (P = 0.313). Among the 2,414 participants with fractures, there were 3,814 fractured vertebral bodies, averaging 1.58 per participant. The distribution of fracture grades was 68.2% G1, 21.4% G2, and 10.4% G3. The most commonly affected vertebrae were T11, T12, and L1, accounting for nearly 75% of fractures in both males and females. Single vertebral fractures were more prevalent in females (67.8% vs. 60.7%, P < 0.001), while double vertebral fractures were more common in males (28.6% vs. 20.7%, P < 0.001). No significant difference was found in the prevalence of multiple (three or more) vertebral fractures between males and females (10.6% vs. 11.5%). The prevalence of thoracic-lumbar fractures, single thoracic fractures, and single lumbar fractures was 17.8%, 55.3%, and 26.9% in males and 18.0%, 48.0%, and 34.0% in females. Males had a higher risk of thoracic fractures (P < 0.001), while females had a higher prevalence of lumbar fractures (P < 0.001).
The prevalence of vertebral fractures in postmenopausal females in Shanghai was lower than in Beijing across all age groups: 11.1% vs. 22.6% in the 60–69 age group, 20.0% vs. 31.4% in the 70–79 age group, and 30.1% vs. 58.1% in the over 80 age group. Similarly, the prevalence among males in Shanghai was lower than in Hong Kong: 14.4% vs. 15.2% in the 65–69 age group, 17.9% vs. 19.9% in the 70–79 age group, and 19.8% vs. 35.9% in the over 80 age group.
The study found that the prevalence of vertebral fractures increased with age in females, consistent with findings from other regions. However, no such correlation was observed in males, where the prevalence remained stable across age groups. Males had a higher bone mineral density (BMD) than females, and reduced BMD of the total hip and femoral neck was associated with increased odds of having a prevalent vertebral fracture. This may explain the difference in fracture grades between males and females, with 83.3% of fractures in males being G1 and occurring at T11 or T12, while 43.3% of fractures in females were G2 or G3 and occurred at T12 or L1.
In conclusion, the prevalence of vertebral fractures among the elderly in Shanghai was 17.2% overall, with 17.0% in males and 17.3% in females. Males were at greater risk of mild, thoracic, and double vertebral fractures, while females were more likely to experience moderate or severe, lumbar, and single vertebral fractures. The prevalence increased with age in females but remained stable in males. These findings highlight the need for targeted interventions to prevent and manage osteoporotic vertebral fractures in the elderly population.
doi.org/10.1097/CM9.0000000000000332
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