欧洲社区居住的老年人骨质疏松性椎体骨折的患病率和发病率：DO-HEALTH试验的观察性分析

Prevalence and incidence of osteoporotic vertebral fractures in community-dwelling European older adults: an observational analysis of the DO-HEALTH trial.

作者信息

Albrecht Andreas P, Kistler-Fischbacher Melanie, De Godoi Rezende Costa Molino Caroline, Armbrecht Gabriele, Freystaetter Gregor, Theiler Robert, Kressig Reto W, Da Silva Jose A P, Rizzoli René, Wanner Guido A, Egli Andreas, Dawson-Hughes Bess, Bischoff-Ferrari Heike A

机构信息

Department of Aging Medicine and Aging Research, University of Zurich, Zurich, Switzerland.

Centre On Aging and Mobility, University of Zurich, Zurich, Switzerland.

出版信息

Osteoporos Int. 2025 Apr 25. doi: 10.1007/s00198-025-07489-y.

DOI:10.1007/s00198-025-07489-y

PMID:40278864

Abstract

UNLABELLED

We examined vertebral fracture (VF) prevalence, incidence, and treatment among 1488 older adults. VF prevalence and incidence were higher in women, older participants, and those with low bone density. In addition to VFs being underdiagnosed (only 20.7% of VFs clinically recognized), treatment rates were low, underscoring the need for improved screening and management.

PURPOSE

To estimate prevalence and incidence of osteoporotic VFs and VF progressions overall and by sex, age, and bone status and to describe the proportion of participants with VFs in reporting osteoporosis (OP) medication use.

METHODS

This observational analysis of the DO-HEALTH trial, a three-year, randomized, controlled trial among community-dwelling adults age ≥ 70 years, includes a subsample of participants recruited at four study sites equipped with DXA machines. Prevalence and incidence rates (IR) of VFs and VF progressions were described overall and by subgroups of sex, age, and bone status. Incidence of VFs which were clinically recognized was also estimated. Further, we estimated the proportion of participants on OP medication.

RESULTS

A total of 1488 participants were included (mean age 74.9 years, 63.1% women, 77.0% had osteopenia or osteoporosis). One hundred forty-four (9.7%) participants had at least one radiographic VF at baseline and of those 19.4% participants reported OP medication use. Over the three-year follow-up, 50 participants sustained 58 new radiographic VFs (IR 1.4, 95% CI 1.1, 1.9). Of the 58 radiographic VFs, only 12 (20.7%) were clinically recognized. Furthermore, 31 participants sustained 35 VF progressions (N = 157; IR 7.7, 95% CI 5.5, 10.7). Prevalence and incidence were significantly higher in women, in older participants and those with osteopenia or osteoporosis compared to those with normal bone density.

CONCLUSIONS

This study suggests a high prevalence and incidence of VFs in community-dwelling European older adults. Underdiagnosis may be even more prevalent than previously observed, and treatment rates were low.

摘要

未标注

我们调查了1488名老年人的椎体骨折（VF）患病率、发病率及治疗情况。女性、老年参与者以及骨密度较低者的VF患病率和发病率更高。除了VF诊断不足（临床上仅识别出20.7%的VF）外，治疗率也很低，这突出表明需要改进筛查和管理。

目的

总体及按性别、年龄和骨状态估计骨质疏松性VF和VF进展的患病率和发病率，并描述报告使用骨质疏松症（OP）药物的VF参与者比例。

方法

本研究对DO-HEALTH试验进行观察性分析，该试验是一项针对年龄≥70岁的社区居住成年人的为期三年的随机对照试验，包括在四个配备双能X线吸收仪（DXA）的研究地点招募的参与者子样本。总体及按性别、年龄和骨状态亚组描述VF和VF进展的患病率和发病率（IR）。还估计了临床识别的VF发病率。此外，我们估计了使用OP药物的参与者比例。

结果

共纳入1488名参与者（平均年龄74.9岁，63.1%为女性，77.0%患有骨量减少或骨质疏松症）。144名（9.7%）参与者在基线时有至少一处影像学VF，其中19.4%的参与者报告使用OP药物。在三年随访期间，50名参与者发生了58处新的影像学VF（IR 1.4，95%CI 1.1，1.9）。在这58处影像学VF中，仅12处（20.7%）被临床识别。此外，31名参与者发生了35处VF进展（N = 157；IR 7.7，95%CI 5.5，10.7）。与骨密度正常者相比，女性、老年参与者以及患有骨量减少或骨质疏松症者的患病率和发病率显著更高。