Incidence and Predictors of Vertebral Fractures in U.S. Postmenopausal Women: A Nationwide Analysis

Vertebral fractures are the most prevalent osteoporotic fractures worldwide and are particularly prevalent in postmenopausal women. The last major population-based study assessing the prevalence of vertebral fractures in the United States was the Study of Osteoporotic Fractures (1999). Since then, studies have been limited by sample size and population generalizability.

The PearlDiver M165 database was used to obtain a randomized sample of 500,000 women over age 55. Women with a diagnosed vertebral fracture were identified via International Classification of Diseases codes and compared with those without by multivariate analysis of potential risk factors: age, geographic region, insurance, diabetes, substance use, osteoporosis history, premature menopause, body mass index (BMI), and hormone replacement therapy (HRT) (estrogen alone versus combination therapy). Dual-x-ray absorptiometry scan utilization was also analyzed.

15,328 of 500,000 women were newly diagnosed with vertebral fracture. Predictors of fracture included older age (age 75+ odds ratios [OR]: 3.92), geographic region, insurance (Medicaid OR: 1.26, Medicare OR: 1.06 versus commercial), diabetes (Type 1 OR: 1.12, Type 2 OR: 1.10), substance use (tobacco OR: 1.52, alcohol OR: 1.60, opioid OR: 1.94), osteoporosis (with fracture history OR: 3.92, without OR: 2.91), and decreased BMI (BMI < 18.5 OR: 1.31, with increasing BMI incrementally protective). Combination HRT did not significantly alter odds of vertebral fracture compared with estrogen alone.

This study provides an updated and nationally representative estimation of vertebral fracture prevalence among postmenopausal women in the United States (3.07% diagnosed, extrapolated to approximately 9.3% prevalence) and highlights risk factors associated with fracture, with the goal of improving screening and management in postmenopausal women.