Prevalence of Osteoporotic Vertebral Fracture Among Community-Dwelling Elderly in Shanghai
Osteoporosis causes over 9 million fractures worldwide every year, making it one of the most costly and disabling health issues for older adults. Vertebral fractures—breaks in the bones of the spine—are its most common consequence, often leading to pain, disability, and a higher risk of future fractures. Now, a large-scale study from Shanghai sheds new light on how common these fractures are among community-dwelling seniors, and how risks differ between men and women.
The research, published in the Chinese Medical Journal in 2019 by Chao Gao, Zhen-Lin Zhang (from the Metabolic Bone Disease and Genetics Research Unit at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital), and colleagues from six Shanghai community health centers, analyzed data from 14,075 elders (6,313 men aged 60–97; 7,762 women aged 60–98) who participated in the Shanghai Community-dwelling Elderly Health Examination (SCEHE) between 2014 and 2016. All participants underwent lateral X-rays of the thoracic and lumbar spine (T4-L4), and fractures were graded using the Genant semi-quantitative system—a widely used method to classify severity as mild (grade 1), moderate (grade 2), or severe (grade 3).
Key Findings: How Common Are Vertebral Fractures in Shanghai Seniors?
Overall, 17.2% of participants had at least one osteoporotic vertebral fracture. For men, the prevalence was 17.0%; for women, it was slightly higher at 17.3%. But the trends varied sharply by age and sex:
- Women: Fracture risk rose steadily with age. Prevalence was significantly higher in women aged 75–79 (vs. younger groups) and even more so in those 80 and older—a pattern seen in cities like Beijing and countries like the U.S.
- Men: Fracture prevalence stayed relatively stable across age groups (around 18%), with no clear increase as they got older. This aligns with prior research showing weaker links between age and vertebral fractures in men.
When it came to fracture type and location, the study uncovered striking sex differences:
- Men: 83% of fractures were mild (grade 1), mostly affecting the lower thoracic spine (T11 or T12). They were also more likely to have two fractured vertebrae (double fractures) than women.
- Women: Nearly 44% of fractures were moderate or severe (grades 2–3), often in the lumbar spine (T12 or L1). Women were more prone to single fractures than men.
Who Is at Higher Risk?
The study compared characteristics of seniors with and without fractures:
- Men: Fractured participants were more likely to be older, shorter, lighter, have a higher rate of stroke (5.5% vs. 3.7%), and a lower rate of diabetes (12.8% vs. 16.5%).
- Women: Fractured participants were also older, shorter, and lighter, with a higher rate of hypertension (41.2% vs. 37.5%).
How Does Shanghai Compare to Other Regions?
Shanghai’s fracture rates were lower than in some other Chinese cities and regions:
- Women: Shanghai postmenopausal women had lower rates than those in Beijing (11.1% vs. 22.6% for 60–69-year-olds; 30.1% vs. 58.1% for 80+).
- Men: Shanghai men had lower rates than community-dwelling men in Hong Kong (14.4% vs. 15.2% for 65–69-year-olds; 19.8% vs. 35.9% for 80+).
What Does This Mean for Seniors and Healthcare?
The study highlights that while vertebral fractures are common in Shanghai’s elderly population, risk and fracture type vary significantly between men and women. For women, age is a key factor—screening and prevention efforts may need to focus more on those 75 and older. For men, even though prevalence stays stable with age, mild fractures are common, so awareness of risk factors like stroke and body size could help with early detection.
By focusing on community-dwelling elders (rather than hospital patients), the research provides a more accurate picture of how widespread vertebral fractures are in everyday life—critical for tailoring public health strategies to protect Shanghai’s growing senior population.
The original study was published in the Chinese Medical Journal in 2019. For more details, you can access the full paper via doi.org/10.1097/CM9.0000000000000332.
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