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Why do geriatric outpatients have so many moderate and severe vertebral fractures? Exploring prevalence and risk
Hanna C van der Jagt-Willems1, Marike van Hengel, Marijn Vis
1Department of Geriatrics, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. h.vanderjagt@slz.nl
Objectives:
to determine the prevalence of vertebral fractures and their risk factors in geriatric patients.
Design:
prospective cohort study.
Setting:
teaching hospital in Amsterdam, The Netherlands.
Subjects:
three hundred and three geriatric patients, who had their first visit at a diagnostic day hospital between April and August 2007.
Measurements:
lateral X-rays of the lumbar spine and chest were performed; vertebral fractures were scored according to the semi-quantitative method of Genant by trained observers and compared with the official report of radiologists. Co-morbidity, reported falls, mobility and cognitive function were scored.
Results:
vertebral fractures were observed in 51% (156/303) of geriatric patients. Sixty-nine per cent (107/156) of these fractures were moderate to severe. In 21% (33/156) of the patients with a fracture, vertebral fractures were diagnosed on the lumbar spine X-ray alone. Patients with vertebral fractures had more previous non-vertebral fractures (odds ratio: 2.40 95% CI: 1.40-4.10), had lower serum albumin levels (OR: 0.92 95% CI: 0.87-0.97) and more current prednisone use (OR: 8.94 95% CI: 1.12-71.45). Co-morbidity and cognitive decline were not identified as risk factors. Radiologists reported vertebral fractures in 53% (82/156) of the cases.
Conclusion:
this study showed a very high prevalence of vertebral fractures in geriatric patients; particularly the high prevalence of moderate and severe fractures is remarkable. Because of this high prevalence, the routinely performed lateral X-ray of the chest should be used to look for vertebral fractures. An additional X-ray of the lumbar spine might be useful in patients without vertebral fractures on the chest X-ray.
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