Prevalence and characteristics of morphometric vertebral fractures in the Spanish population: Data from the OsteoSER study.

Abstract

Most vertebral fractures are asymptomatic and remain underdiagnosed. Vertebral Fracture Assessment (VFA) by Dual-energy X-ray Absorptiometry (DXA) enables low-radiation detection of morphometric vertebral fractures (MVFs). The present study estimated the prevalence of MVFs in Spanish adults aged ≥40 years and characterized affected individuals. This multicenter cross-sectional study included 1082 adults (aged 40-80 years) from 15 primary care centers across six Spanish provinces. VFA was performed using a mobile DXA unit (Hologic® Horizon W). Two rheumatologists independently evaluated vertebrae T5-L4 using Genant's method; discrepancies were resolved by consensus. Bone mineral density (BMD) and clinical data were recorded. Primary care physicians reviewed records and imaging to classify MVFs as clinical fragility (CFVFs), traumatic, or morphometric-only. 244 MVFs were identified in 171 participants (15.9%; 95% CI, 13.8-18.2). MVFs were more frequent in men (19.3% vs 12.5%), older individuals, and those with prior non-vertebral fragility fractures, lower hip BMD, or osteoporosis (all p < 0.01). Most were grade 1 (62.7%), anterior (79.9%), and located at the thoracolumbar junction. After review, 52 participants (4.8%) had CFVFs, 19 traumatic fractures, and 100 morphometric fractures. CFVFs were mainly grade 2, anterior, and thoracolumbar. They occurred more often in older women and were associated with previous nonvertebral fragility fractures. MVFs affected nearly one in six Spanish adults aged ≥40 years, and were independently associated with male sex, older age, and lower hip BMD. CFVFs represented a smaller, underdiagnosed subset and were more frequent in older women, with distinctive severity and localization patterns.