Prevalence of Osteoporotic Vertebral Fracture Among Community-Dwelling Elderly in Shanghai

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Prevalence of Osteoporotic Vertebral Fracture Among Community-Dwelling Elderly in Shanghai

If you’re over 60 living in Shanghai, how likely are you to have an osteoporotic vertebral fracture—a break in the spine bones caused by osteoporosis-related bone weakening? A 2019 study by researchers from Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and local community health centers offers key insights into this question, shedding light on the burden of spine fractures among the city’s aging population.

The Study: Who, How, and Why

The research team focused on 14,075 community-dwelling elders (6,313 men and 7,762 women) aged 60 to 98, recruited through the Shanghai Community-dwelling Elderly Health Examination (SCEHE) from six Shanghai neighborhoods: Fenglin, Lingyun, Longhua, Qixian, Sanlin, and Xujiahui. Participants volunteered for lateral spine X-rays (covering the 4th thoracic to 4th lumbar vertebrae, T4-L4) and provided health information—including age, height, weight, menopause status (for women), and histories of chronic conditions like hypertension, diabetes, and stroke.

To assess fractures, the team used the Genant semi-quantitative system, a gold standard for grading vertebral deformities:

  • Mild (Grade 1, G1): 20–25% height loss or mild shape change
  • Moderate (Grade 2, G2): 25–40% height loss or significant shape change
  • Severe (Grade 3, G3): >40% height loss or collapse

An experienced radiologist reviewed all X-rays, and the study was approved by the ethics committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital.

Key Findings: Prevalence and Risk Profiles

The study found an overall vertebral fracture prevalence of 17.2% among Shanghai’s elderly—17.0% for men and 17.3% for women. But the risks differed sharply by sex and age:

Women: Risk Rises With Age

For women, fracture risk increased steadily as they got older:

  • 11.1% in 60–69-year-olds
  • 20.0% in 70–79-year-olds
  • 30.1% in those over 80

Women with fractures were also more likely to be older (74.2 vs. 70.9 years), shorter (152.2 vs. 154.5 cm), and lighter (56.5 vs. 57.9 kg) than non-fractured women. They also had a higher rate of hypertension (41.2% vs. 37.5%).

Men: Stable Risk, Mild Fractures

Men’s fracture risk stayed consistent across age groups (around 18%), with no significant increase as they aged. Fractured men were slightly older (72.1 vs. 71.2 years), shorter (165.2 vs. 166.3 cm), and lighter (66.5 vs. 67.4 kg) than non-fractured men. They also had a higher rate of stroke (5.5% vs. 3.7%) and lower rate of diabetes (12.8% vs. 16.5%).

Fracture Type Differences

  • Severity: Women were far more likely to have moderate (G2) or severe (G3) fractures (43.3% vs. 16.7% in men). Most men’s fractures (83.3%) were mild (G1).
  • Location: Men’s fractures often occurred in the thoracic spine (T11-T12); women’s fractures were more common in the lumbar spine (T12-L1).
  • Number: Men were more likely to have double fractures (28.6% vs. 20.7% in women), while women had more single fractures (67.8% vs. 60.7% in men).

How Shanghai Compares to Other Regions

Shanghai’s fracture rates were lower than similar studies in other Chinese cities:

  • Women vs. Beijing: Shanghai’s 60–69-year-old women had a 11.1% fracture rate vs. 22.6% in Beijing; over 80, 30.1% vs. 58.1%.
  • Men vs. Hong Kong: Shanghai’s 70–79-year-old men had a 17.9% rate vs. 19.9% in Hong Kong; over 80, 19.8% vs. 35.9%.

These differences may reflect variations in lifestyle, screening practices, or bone health awareness.

Why This Matters for Public Health

The study’s results are critical for tailoring osteoporosis prevention and care in Shanghai:

  • Older women: Targeted screening for moderate/severe lumbar fractures, as their risk rises with age.
  • Men: Education on mild thoracic fractures, which are common but often undiagnosed.
  • Chronic conditions: Addressing stroke (in men) and hypertension (in women) as potential risk factors.

As Shanghai’s population ages—14.3% of residents were over 65 in 2020—understanding vertebral fracture patterns helps prioritize resources for those most at risk.

Conclusion

For Shanghai’s community-dwelling elderly, osteoporotic vertebral fractures affect 1 in 6 people overall—with key differences between men and women. Women face rising risk as they age and are more likely to have severe fractures, while men’s risk stays stable but involves milder, thoracic fractures. These findings provide a roadmap for reducing the burden of osteoporosis in one of China’s largest cities.

The study, Prevalence of osteoporotic vertebral fracture among community-dwelling elderly in Shanghai, was published in the Chinese Medical Journal in 2019 by Chao Gao, Yang Xu, Li Li, and colleagues from Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and seven Shanghai community health centers.

doi.org/10.1097/CM9.0000000000000332

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