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Spinal fractures in the elderly

Vertebral compression fractures are very common among older people, and those with such fractures are at high risk of developing new ones. Findings in a new thesis from the University of Gothenburg show that a simple x-ray method should be introduced as a routine procedure in Swedish healthcare. More elderly patients can be diagnosed later and given the most effective drugs.

Vertebral compression means that the spine is compressed, causing a fracture in one of the vertebrae. Vertebral compression fractures (VCFs) occur easily in people with osteoporosis and particularly affect older women.

The thesis confirms previous research showing that 25% of older women between the ages of 75 and 80 have VCF. However, the majority are unaware that they cause back pain – only about a third are diagnosed. According to population statistics from Statistics Sweden (SCB), there are at least 40,000 older women in Sweden who do not know they have VCFs.

Diagnostic imaging required

Vertebral compressions do not necessarily result in obvious symptoms. Imaging is required to detect these spinal fractures. If more people were diagnosed, many fractures, much pain and heavy costs could have been avoided.

"People who have suffered a vertebral compression fracture are more than twice as likely to get a new one, which means they belong to the high-risk group. Therefore, they should be considered for the most effective drugs that not only stop the bones from collapsing, but also build them up," says the author of the thesis. Lisa Johansson, PhD student at Sahlgrenska Academy, University of Gothenburg.

Efforts to prevent fractures in the elderly differ across the country. Some, but not all, areas have built-in "fracture liaison services" as they are known in Sweden. These allow fracture investigations to be structured in a way that greatly reduces the risk of recurrent fractures. When fractures occur in elderly patients, hip and lumbar spine bone densities are examined by dual-energy X-ray absorptiometry (DXA) and it is understood whether they need osteoporosis treatment. DXA can then also be used to obtain a side view of the thoracic and lumbar spine with a method called vertebral fracture assessment (VFA), in which vertebral height is analyzed.

It should be a routine procedure

The thesis demonstrates the great clinical benefit of VFA and the results suggest that the method should be introduced as a routine procedure in healthcare across the country.

"The VFA method provides a very low radiation dose and is fast, inexpensive, simple, and effective in finding vertebral compressions. It is a valuable method for diagnosing relevant compressions and significantly improves fracture risk assessment in older women," says Johansson.

The thesis is based on a SUPERB (Sahlgrenska University Hospital Prospective Assessment of Bone Fracture Risk) population study involving 3,028 women aged 75 to 80 years in Gothenburg. The study shows that women with VCF have greater hip bone density and worse physical functional capacity and health. Even if classified as mild, women with identifiable vertebral compression had a significantly increased risk of fracture, completely independent of other risk factors and bone density.

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