Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS)

Byline: D.K. Roy (2), T.W. O'Neill (2), J.D. Finn (2), M. Lunt (2), A.J. Silman (2), D. Felsenberg (3), G. Armbrecht (3), D. Banzer (4), L.I. Benevolenskaya (5), A. Bhalla (6), J. Bruges Armas (7), J.B. Cannata (8), C. Cooper (9), J. Dequeker (10), M.N. Diaz (8), R. Eastell (11), O.B. Yershova (12), B. Felsch (13), W. Gowin (3), S. Havelka (14), K. Hoszowski (15), A.A. Ismail (2), I. Jajic (16), I. Janott (17), O. Johnell (18), J.A. Kanis (19), G. Kragl (20), A. Lopez Vaz (21), R. Lorenc (22), G. Lyritis (23), P. Masaryk (24), C. Matthis (25), T. Miazgowski (26), C. Gennari (27), H.A.P. Pols (28), G. Poor (29), H.H. Raspe (25), D.M. Reid (30), W. Reisinger (31), C. Scheidt-Nave (32), J.J. Stepan (14), C.J. Todd (33), K. Weber (34), A.D. Woolf (35), J. Reeve (36) Keywords: KeywordsaIncident vertebral fracture; Osteoporosis; Prospective study; Risk factors Abstract: aThe aim of this analysis was to determine the influence of lifestyle, anthropometric and reproductive factors on the subsequent risk of incident vertebral fracture in men and women aged 50--79 years. Subjects were recruited from population registers from 28 centers across Europe. At baseline, they completed an interviewer-administered questionnaire and had lateral thoraco-lumbar spine radiographs performed. Repeat spinal radiographs were performed a mean of 3.8 years later. Incident vertebral fractures were defined morphometrically and also qualitatively by an experienced radiologist. Poisson regression was used to determine the influence of the baseline risk factor variables on the occurrence of incident vertebral fracture. A total of 3173 men (mean age 63.1 years) and 3402 women (mean age 62.2 years) contributed data to the analysis. In total there were 193 incident morphometric and 224 qualitative fractures. In women, an age at menarche 16 years or older was associated with an increased risk of vertebral fracture (RR=1.80 95%CI 1.24, 2.63), whilst use of hormonal replacement was protective (RR=0.58 95%CI 0.34, 0.99). None of the lifestyle factors studied including smoking, alcohol intake, physical activity or milk consumption showed any consistent associations with incident vertebral fracture. In men and women, increasing body weight and body mass index were associated with a reduced risk of vertebral fracture though, apart from body mass index in men, the confidence intervals embraced unity. For most variables the strengths of the associations observed were similar using the qualitative and morphometric approaches to fracture definition. In conclusion our data suggest that modification of other lifestyle risk factors is unlikely to have a major impact on the population occurrence of vertebral fractures. The important biological mechanisms underlying vertebral fracture risk need to be explored using new investigational strategies. Author Affiliation: (1) ARC Epidemiology Unit, Stopford Building, University of Manchester, Manchester, M13 9PT, UK Tel: +44 (0)161 2755040 Fax: +44 (0)161 2755043 e-mail: Terry@fs1.ser.man.ac.uk, GB (2) ARC Epidemiology Unit, University of Manchester, Manchester, UK, GB (3) Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany, DE (4) Behring Hospital, Berlin, Germany, DE (5) Institute of Rheumatology, Moscow, Russia, RU (6) Royal National Hospital for Rheumatic Diseases, Bath, UK, GB (7) Hospital de Angra do Herismo, Azores, Portugal, PT (8) Asturia General Hospital, Oviedo, Spain, ES (9) University of Southampton, Southampton General Hospital, Southampton, UK, GB (10) University Hospital, Leuven, Belgium, BE (11) Bone Metabolism Group, Northern General Hospital, Sheffield, UK, GB (12) Medical Institute, Yaroslavl, Russia, RU (13) Clinic for Internal Medicine, Jena, Germany, DE (14) Department of Internal Medicine, Charles University, Prague, Czech Republic, CZ (15) Medical Centre, Wilenska 18, Warsaw, Poland, PL (16) Clinical Hospital, Zagreb, Croatia, HR (17) Ruhr University, Bochum, Germany, DE (18) Lund University, Malmo, Sweden, SE (19) Centre for Metabolic Bone Disease, University of Sheffield, UK, GB (20) Medical Academy, Erfurt, Germany, DE (21) Hospital de San Joao, Oporto, Portugal, PT (22) The Children's Memorial Health Institute, Warsaw Poland, PL (23) Laboratory for the Research of Musculoskeletal System, University of Athens, Athens, Greece, GR (24) Institute of Rheumatic Diseases, Piestany, Slovakia, SK (25) Institute of Social Medicine, Lubeck, Germany, DE (26) Academy of Medicine, Szczecin, Poland, PL (27) Institute of Clinical Medicine, University of Siena, Siena, Italy, IT (28) Department of Epidemiology and Internal Medicine, Erasmus University, Rotterdam, The Netherlands, NL (29) National Institute of Rheumatology and Physiotherapy, Budapest, Hungary, HU (30) Department of Medicine and Therapeutics, University of Aberdeen, UK, GB (31) Institute for Diagnostic Radiology, Humboldt University, Berlin, Germany, DE (32) Department of General Practice, University of Goettingen, Germany, DE (33) School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK, GB (34) Department of Medicine, University Hospital, Graz, Austria, AT (35) Royal Cornwall Hospital, Truro, UK, GB (36) Institute of Public Health, Cambridge, UK, GB Article note: Received: 24 May 2002 / Accepted: 27 August 2002 RID='*' ID='*' For full listing of participants, please see appendix RID='*' ID='*' Project co-ordinators AcknowledgementaThe study was financially supported by a European Union Concerted Action Grant under Biomed-1 (BMH1CT920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 &amp 940229. The central coordination was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536), and the European Foundation for Osteoporosis and Bone Disease. The EU's PECO program linked to BIOMED 1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin and Moscow centers. Data collection from Croatia was supported by a grant from the Wellcome Trust. The central X-ray evaluation was generously sponsored by the Bundesministerium fur Forschung and Technologie, Germany. Individual centers acknowledge the receipt of locally acquired support for their data collection. We would like to thank the following individuals: Aberdeen, UK: Rita Smith Cambridge &amp Harrow, UK: Anna Martin, Judith Walton Truro, UK: Mrs Joanna Parsons Oviedo, Spain : J Bernardino Diaz Lopez, Ana Rodriguez Rebollar.