Vertebral Fractures Assessed by Dual-Energy X-Ray Absorptiometry and All-Cause Mortality: The Tromsø Study, 2007–2020

• Published in: American Journal of Epidemiology
• Main Authors: Johansson, Jonas, Emaus, Nina, Geelhoed, Bastiaan, Sagelv, Edvard, Morseth, Bente
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press (OUP) 2022
• Subjects: Norway; Tromsø
• Online Access: http://dx.doi.org/10.1093/aje/kwac161; https://academic.oup.com/aje/advance-article-pdf/doi/10.1093/aje/kwac161/46650672/kwac161.pdf; https://academic.oup.com/aje/article-pdf/192/1/62/48361238/kwac161.pdf

Abstract Vertebral fractures have been associated with increased mortality, but findings are inconclusive, and many vertebral fractures avoid clinical attention. We investigated this association in a general population of 2,476 older adults aged ≥55 years from Tromsø, Norway, who were followed over 2007–2020, using dual-energy x-ray absorptiometry (DXA) at baseline to evaluate vertebral fractures (mild, moderate, or severe). We used multiple Cox regression models to estimate hazard ratios (HRs) for all-cause mortality, adjusted for age, sex, body mass index, education, smoking, alcohol intake, cardiovascular disease, and respiratory disease. Mean follow-up in the cohort was 11.2 (standard deviation, 2.7) years; 341 participants (13.8%) had ≥1 vertebral fracture at baseline, and 636 participants (25.7%) died between baseline and follow-up. Full-adjustment models showed a nonsignificant association between vertebral fracture status (yes/no) and mortality. Participants with ≥3 vertebral fractures (HR = 2.43, 95% confidence interval: 1.57, 3.78) or ≥1 severe vertebral fracture (HR = 1.65, 95% confidence interval: 1.26, 2.15) had increased mortality compared with those with no vertebral fractures. Dual-energy x-ray absorptiometry–based screening could be a potent and feasible tool in detecting vertebral fractures that are often clinically silent yet independently associated with premature death. Our data indicated that detailed vertebral assessment could be warranted for a more accurate survival estimation.