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

Authors: ALBRECHT, ANDREAS - UNIVERSITY OF ZURICH; KISTLER-FISCHBACHER, MELANIE - UNIVERSITY OF ZURICH; REZENDE COSTA MOLINO, CAROLINE - UNIVERSITY OF ZURICH; ARMBRECHT, GABRIELE - CHARITE' UNIVERSITY HOSPITAL BERLIN; FREYSTAETTER, GREGOR - UNIVERSITY OF ZURICH; THEILER, ROBERT - UNIVERSITY OF ZURICH; KRESSIG, RETO - UNIVERSITY HOSPITAL FOR GERIATRIC MEDICINE AND REHABILITATION FELIX PLATTER; DA SILVA, JOSE - UNIVERSITY OF COIMBRA; RIZZOLI, RENE - GENEVA UNIVERSITY HOSPITAL; WANNER, GUIDO - PRIVATKLINIK BETHANIEN; EGLI, ANDREAS - UNIVERSITY OF ZURICH; DAWSON-HUGHES, BESS - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; BISCHOFF-FERRARI, HEIKE - UNIVERSITY OF ZURICH

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/1/2025
Publication Date: 4/25/2025
Citation: Albrecht, A., Kistler-Fischbacher, M., Rezende Costa Molino, C.D., Armbrecht, G., Freystaetter, G., Theiler, R., Kressig, R.W., Da Silva, J.A., Rizzoli, R., Wanner, G.A., Egli, A., Dawson-Hughes, B., Bischoff-Ferrari, H.A. 2025. Prevalence and incidence of osteoporotic vertebral fractures in community-dwelling European older adults: An observational analysis of the DO-HEALTH trial . Osteoporosis International. 36:1077-1088. https://doi.org/10.1007/s00198-025-07489-y.
DOI: https://doi.org/10.1007/s00198-025-07489-y

Interpretive Summary: This study was done to determine the prevalence and incidence of spine fractures and the proportion of those with spine fractures who were taking medication to lower future fracture risk. Included in this study are 1488 adults, age = 70 years, who participated in the European DO-HEALTH trial. At baseline, 9.7% of the participants had at least one spine fracture, and of those, only 18.9% reported taking an osteoporosis medication. Over the three-year follow-up, 50 participants had 58 new spine fractures. Risk factors for spine fracture in this study were being female, older, and having low bone density. This study suggests a high prevalence and incidence of VF in generally healthy community-dwelling European older adults. Underdiagnoses may be even more prevalent than previously observed and treatments rates were low.

Technical Abstract: Purpose To estimate prevalence and incidence of osteoporotic VF and VF progressions overall and by sex, age, bone status, and country and to describe the proportion of participants with VF receiving osteoporosis (OP) medication. 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 VF and VF progressions were described overall and by subgroups of sex, age, bone status and country. Incidence of VF which were clinically recognized were 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). 144 (9.7%) participants had at least one radiographic VF at baseline and of those 18.9% participants reported OP medication intake. Over the three-year follow-up, 50 participants sustained 58 new radiographic VF (IR 1.4, 95% CI 1.1, 1.9). Of the 58 radiographic VF, 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 OP compared to those with a normal bone density. Conclusions This study suggests a high prevalence and incidence of VF in community-dwelling European older adults. Underdiagnosis may be even more prevalent than previously observed and treatments rates were low.