Many Healthy Postmenopausal Women With Osteopenia Have Vertebral Fractures

By Lisa Rapaport

September 08, 2020

(Reuters Health) - Nearly one in three apparently healthy postmenopausal women with osteopenia may have morphometric vertebral fractures, a study of Thai women suggests.

Researchers examined data on 490 postmenopausal women with osteopenia, with a mean age of 59.9 years and mean BMI of 24.3. Overall, 29% of the women in the study had morphometric vertebral fractures.

"Our results raise the concern that vertebral fracture screening criteria should be reconsidered and that screening at an earlier age than the current recommendations maybe appropriate," said study co-author Dr. Chatlert Pongchaiyakul of the division of endocrinology and metabolism at Khon Kaen University inThailand.

"We know that patients with history of fragility fractures, including vertebral fractures, have an increased risk of recurrent fractures, and they are candidate for antiosteoporosis medication, regardless of BMD results," Dr. Pongchaiyakul said by email. "Identifying morphometric vertebral fracture in osteopenic women is crucial because it influences the decision making regarding the choice of treatment."

Among the women in the study with morphometric vertebral fractures, 62% had grade 1 vertebral fractures, 19.3% had grade 2 vertebral fractures, and 18.7% had grade 3 vertebral fractures, researchers report in Menopause.

In the group with morphometric vertebral fractures, 4.9% of the women were 50 years old or younger, 40.1% were 50-59 years old, 38% were 60-69 years old, and 16.9% were 70 years or older.

The degree of osteopenia didn't appear to impact morphometric vertebral fracture risk in the study.

Both age and Fracture Risk Assessment Tool (FRAX) scores were positively associated with vertebral fractures.

Compared to women who didn't have morphometric vertebral fractures, those who did had higher FRAX scores for both hip fractures and major osteoporotic fractures, regardless of whether bone mineral density was used to calculate FRAX scores.

Following current screening guidelines would fail to identify more than half of the women in the study with morphometric vertebral fractures, the analysis found.

Limitations of the study include the small size, self-reported data on any lost height among study participants, and the potential for results from women in Northern Thailand to be unrepresentative of women from the entire Thai population or of women from other racial or ethnic groups.

In the U.S., for example, many women have a higher BMI than the Thai women in this study, and this might lead to different results among American women, said Jane Cauley, an epidemiology professor at the Graduate school of Public Health at the University of Pittsburgh in Pennsylvania.

It is well established that more fractures including vertebral fractures occur in osteopenic women because there are lots more osteopenic women, Dr. Cauley, who wasn't involved in the study, said by email.

"What we really need to do is a better job of identifying osteopenic women who are likely to fracture," Dr. Cauley said. "But I definitely would not recommend getting lateral x-rays on all these women."

SOURCE: Menopause, online August 10, 2020.