Prevalence of Osteoporotic Vertebral Fracture Among Community-Dwelling Elderly in Shanghai
Osteoporosis has emerged as a significant global health issue, leading to over nine million fractures annually worldwide. Among these, vertebral fractures are the most common type of osteoporotic fracture, posing a considerable burden on public health services due to their high morbidity and mortality rates. Despite the growing awareness of this condition, 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 of osteoporotic vertebral fractures among community-dwelling elderly in Shanghai, providing valuable insights into the characteristics and risk factors associated with these fractures.
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 voluntarily recruited from six communities across Shanghai: Fenglin, Lingyun, Longhua, Qixian, Sanlin, and Xujiahui. Participants were contacted by community staff to attend physical examinations, which included lateral thoracolumbar (T4-L4) X-ray radiography. Those who agreed to undergo the X-ray examination were informed of the related risks and provided written consent. The radiographs were analyzed using the semi-quantitative system developed by Genant et al., and all images were reviewed by an experienced radiologist within three months.
Basic demographic information, including age, height, weight, and body mass index (BMI), was collected for all participants. For female participants, additional data on years since menopause (YSM) were recorded. Chronic disease histories, such as hypertension, diabetes, coronary heart disease, stroke, hyperlipidemia, chronic liver disease, chronic kidney disease, and malignant tumors, were also obtained. Fasting blood samples were collected for routine blood examinations, hepatic function, renal function, serum lipids, and fasting blood glucose. These measurements were taken at each Community Health Service Center (CHSC) clinical lab, and while different biochemistry systems were used, only qualitative comparisons were made for disease diagnosis.
The study revealed that the overall prevalence of vertebral fractures among the elderly in Shanghai was 17.2%, with 17.0% in males and 17.3% in females. The prevalence of vertebral fractures increased with age in females, with a noticeable rise in the 75–79, 80–84, and over 85 years age groups. In contrast, the prevalence among males remained relatively stable across all age groups, except for a slight increase in the 65–69 and over 85 years age groups. The study also found that males were more likely to experience mild (grade 1) fractures, particularly in the thoracic vertebrae (T11 and T12), while females were more prone to moderate (grade 2) or severe (grade 3) fractures, often occurring in the lumbar vertebrae (L1).
Among the 2,414 participants who suffered vertebral fractures, a total of 3,814 fractured vertebral bodies were identified, indicating an average of 1.58 deformed vertebral bodies per participant. The distribution of fracture grades showed that 68.2% of fractures were grade 1, 21.4% were grade 2, and 10.4% were grade 3. Females had a significantly higher prevalence of grade 2 and grade 3 fractures compared to males across all age groups, except for the 60–64 years group. The most commonly affected vertebrae were T11, T12, and L1, accounting for nearly 75% of all fractures in both males and females.
The study also examined the prevalence of single, double, and multiple vertebral fractures. Females had a higher prevalence of single vertebral fractures (67.8%) compared to males (60.7%), while males had a higher prevalence of double vertebral fractures (28.6%) compared to females (20.7%). No significant difference was observed in the prevalence of multiple (three or more) vertebral fractures between males and females. Additionally, the study found that males were at greater risk of thoracic fractures, whereas females had a higher prevalence of lumbar fractures.
When compared to previous studies, the prevalence of vertebral fractures among post-menopausal females in Shanghai was lower than that reported in Beijing across all age groups. Similarly, the prevalence among males in Shanghai was lower than that reported in Hong Kong. These findings suggest regional variations in the prevalence of vertebral fractures, which may be influenced by differences in lifestyle, healthcare access, and genetic factors.
The study also identified several risk factors associated with vertebral fractures. In males, fractured participants were more likely to be older, shorter, and lighter in weight compared to non-fractured participants. They also had a lower rate of diabetes but a higher rate of stroke. In females, fractured participants were older, shorter, and lighter in weight, with a higher rate of hypertension compared to non-fractured participants. These findings highlight the importance of considering both demographic and clinical factors when assessing the risk of vertebral fractures.
In conclusion, this study provides a comprehensive overview of the prevalence and characteristics of osteoporotic vertebral fractures among community-dwelling elderly in Shanghai. The findings underscore the need for targeted prevention and intervention strategies, particularly for older females and those with specific risk factors. By addressing these issues, it may be possible to reduce the burden of vertebral fractures and improve the quality of life for elderly individuals in Shanghai and beyond.
doi.org/10.1097/CM9.0000000000000332
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