Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures

Although vertebral deformities are known to predict future vertebral deform ities, little is known about their ability to predict other osteoporotic fr actures. We examined the association between prevalent vertebral deformitie s and incident osteoporotic fractures in the Study of Osteoporotic Fracture s, a prospective study of 9704 women aged 65 years and older. Prevalent ver tebral deformities were determined morphometrically from spinal radiographs at baseline and incident deformities from repeat spinal radiographs after a mean of 3.7 years. Appendicular fractures were collected by postcard ever y 4 months for a mean of 8.3 years. During follow-up, 389 women with new ve rtebral deformities, 464 with hip fractures, and 574 with wrist fractures w ere identified, Prevalent vertebral deformities were associated with a 5-fo ld increased risk (relative risk 5.4, 95% confidence interval [CI] 4.4, 6.6 ) of sustaining a further vertebral deformity; the risk increased dramatica lly with both the number and severity of the prevalent deformities. Similar ly, the risks of hip and any nonvertebral fractures were increased with bas eline prevalent deformity, with relative risks of 2.8 (95% CI 2.3, 3.4) and 1.9 (95% CI 1.7, 2.1), respectively. Risk increased with number and severi ty of deformities. These associations remained significant after adjustment for age and calcaneal bone mineral density (BMD). Although there was a sma ll increased risk of wrist fracture, this was not significant after adjusti ng for age and BMD. In conclusion, the presence of prevalent morphometrical ly defined vertebral deformities predicts future vertebral and nonvertebral fractures, including hip but not wrist fractures. Spinal radiographs ident ifying prevalent vertebral deformities may be a useful additional measureme nt to classify further a woman's risk of future fracture.