Vertebral Fracture Status and the World Health Organization Risk Factors for Predicting Osteoporotic Fracture Risk in Japan

Introduction: Vertebral fractures are the most common osteoporotic fracture and the prevalence of vertebral fracture is commonly assessed in clinical practice in Japan. The objective of this study was to evaluate potential risk factors for osteoporotic fractures, including morphometric spine fracture status and the WHO risk factors for predicting 4-year fracture risk.

Methods: A population-based community cohort, the Adult Health Study, consisting of 2613 men and women with mean age of 65 enrolled in Hiroshima was followed prospectively for 4 years. The prevalence and incidence of spine fractures were identified from lateral and posterior-anterior spine radiographs using a semiquantitative method. Information on incident nonvertebral fragility fractures (hip, proximal humeral, and forearm) was collected at interviews by trained nurses and physicians during biennial health examinations.

Results: A model, including spine fracture status in addition to the WHO risk factors, appeared to provide greater prognostic information regarding future fracture risk (gradient of risk/standard deviation: GR/SD=2.73) than a model with the WHO risk factors alone (GR/SD=2.54). In univariate analyses, age, bone mineral density (BMD), prior clinical fracture, and spine fracture status had the highest gradient of risk. The presence of multiple prevalent spine or non-spine fractures significantly increased fracture risk, but, their contributions to the gradient of risk were similar to those when fracture status was categorized as a binary variable. A model considering those four risk factors yielded GR/SD=2.67, indicating that it could capture most of the predictive information provided by the model with spine fracture status plus the WHO risk factors.

Conclusion: The use of age, BMD, prior clinical fracture and spine fracture predicted future fracture risk with greater simplicity and higher prognostic accuracy than consideration of the risk factors included in the WHO tool.