Vertebral Fracture as a Predictor of Subsequent Extremity Fractures: A Systematic Review

Area of Science:

• Orthopedics
• Gerontology
• Epidemiology

Background:

• Vertebral fractures are common osteoporotic fractures, often underdiagnosed.
• Prior fragility fractures heighten the risk of subsequent fractures.
• The specific risk of extremity fractures after vertebral fractures is not well-defined.

Purpose of the Study:

• To assess the risk of subsequent extremity fractures after vertebral fractures in adults aged 50 years and older.
• To characterize the patterns and timing of these subsequent fractures.

Main Methods:

• Systematic review of studies from PubMed, OVID, and Scopus (2005-2025).
• Inclusion criteria: studies reporting subsequent extremity fractures post-vertebral fracture in adults ≥50 years.
• Data extraction: demographics, fracture details, treatment, and incidence of subsequent fractures.

Main Results:

• Eight studies included 488,770 patients with index vertebral fractures.
• Subsequent extremity fracture incidence ranged from 1.4% to 12.4% (aggregated 6.90%).
• Hip fractures were most common (73.3%), followed by forearm/wrist, humerus, and ankle fractures; risk peaked within 1-3 years.
• Subsequent vertebral fractures occurred in 4.82% of patients.

Conclusions:

• Vertebral fractures in adults ≥50 predict subsequent extremity fractures, particularly hip fractures.
• The heightened risk is concentrated in the early post-fracture period.
• Findings support a systemic fracture cascade, necessitating early detection and secondary prevention.