Vertebral Fractures and Mortality in Older Women

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Abstract
OSTEOPOROTIC fractures, especially fractures of the hip, and low bone mineral density are associated with increased mortality.1-6 Women with clinically diagnosed vertebral fractures have a 15% higher mortality than women who do not.7 However, only about one third of vertebral fractures are clinically manifest, and patients with diagnosed vertebral fractures may have more severe and symptomatic fractures than those whose fractures are undiagnosed.8 Therefore, studies focusing on diagnosed vertebral fractures may be biased toward poorer outcomes. Also, the association between vertebral fractures and mortality may result from surveillance bias, since patients who are ill may be more likely to have radiographs that could detect vertebral fractures than those who are healthy. Mortality among women whose vertebral fractures have been identified only by screening radiographs is not known.