[Vertebral fracture: a major risk factor for osteoporosis]

At the age of 50, a women has a lifetime risk of more than 30% to present a radiological vertebral fracture (vertebral deformity). Among the women of 50 to 79 years, 12 to 20% of them have one or more prevalent vertebral deformities. For Switzerland, it represents about 130,000 to 220,000 women. For men, the global prevalence of these fractures is the same. However, they usually happen in younger men who are exposed to greater trauma than women. The situation is more dramatic in patients hospitalised for a hip fracture, because about 3/4 of them have one or more vertebral deformities. It is important to detect these vertebral deformities because they represent a significantly higher risk to have subsequent fractures, particularly vertebral (approximately 5x), but also hip fractures (approximately 2x). This risk remains increased, whatever is the number or the grade of the deformities, although it is higher in patients with many fractures or with severe deformities. It is also important to detect vertebral deformities, because cost-effectiveness of treatments such as bisphosphonates, calcitonin, raloxifen, or PTH is the highest in patients with prevalent vertebral deformities. Unfortunately, only 1/3 of vertebral deformities are diagnosed. In consequence, it is of major importance to develop screening and diagnosis strategies for these deformities. Morphologic vertebral assessment by DXA should be an interesting approach for this purpose.