Osteoporotic vertebral fracture in clinical practice. 669 patients diagnosed over a 10 year period

Objective. Few data are available on clinically diagnosed vertebral fractur e. Information about osteoporotic vertebral fracture has mainly been obtain ed via inferences from epidemiological studies of vertebral deformity. We e valuated the characteristics of patients with osteoporotic vertebral fractu re diagnosed in a rheumatology department over a 10 year period. Methods. Patients with back pain and vertebral fracture diagnosed between J anuary 1990 and December 1999 were recruited from our data base. Patients w ith high energy trauma, malignancies, and metabolic bone diseases other tha n osteoporosis were excluded. These variables were analyzed: sex, age at di agnosis, type of osteoporosis (primary vs secondary), number of fractures a t diagnosis (single vs multiple), and percentage of admissions and length o f stay. Results. Of the 669 patients, 534 (80%) were women and 135 (20%) were men. Age at diagnosis ranged from 30 to 91 yrs, mean 67.1 +/- 9.1. Secondary ost eoporosis was diagnosed in 177 (26%) patients and the frequency was signifi cantly higher in men than women (55% vs 19%; p < 0.001); the most common as sociations for secondary osteoporosis were oral corticosteroids, chronic ob structive airway disease, and rheumatoid arthritis. At diagnosis, half of t he patients presented with multiple fractures. One hundred twenty (18%) pat ients were admitted; length of stay ranged from 5 to 56 days, mean 15.9 +/- 7.7. The frequency of admissions was higher in men than women (27% vs 16%; p < 0.001), higher in patients with secondary osteoporosis than in those w ith primary osteoporosis (33% vs 12%; p < 0.001), and higher in patients wi th multiple fractures than in those with single fractures (27% vs 8%; p < 0 .001). Conclusion. Characteristics of patients recruited from a clinical setting d iffer significantly from those of subjects included in the epidemiological studies. In a rheumatology practice, frequency of secondary osteoporosis, m ainly associated with corticosteroid treatment, is notably high. Admission is by no means a rare event.