Original Full Length Article Vertebral fracture risk factors in postmenopausal women over 50 in Valencia, Spain. A population-based cross-sectional study Gabriel Sanfélix-Gimeno a, ⁎, José Sanfelix-Genovés a, b , Isabel Hurtado a , Begoña Reig-Molla c , Salvador Peiró a a Centro Superior de Investigación en Salud Pública (CSISP), Avda. Cataluña 21, 46020 Valencia, Spain b Fundación de Investigación del Hospital Clínico Universitario, Instituto de Investigación Sanitaria (INCLIVA), Av. Blasco Ibañez, 17, 46010 Valencia, Spain c Centro de Salud de Vilamarxant, Departamento de Valencia-Arnau de Vilanova-Lliria, Agencia Valenciana de la Salud, C/Fuente Nueva, S/N, 46191 Vilamarxant, Valencia, Spain abstract article info Article history: Received 27 March 2012 Revised 22 October 2012 Accepted 22 October 2012 Available online 26 October 2012 Edited by: Felicia Cosman Keywords: Vertebral fracture Osteoporosis Bone mineral density Risk factors Purpose: This study aims to estimate the prevalence of risk factors for osteoporotic vertebral fracture and an- alyze the possible associations between these factors and the presence of densitometric osteoporosis and prevalent morphometric vertebral fracture. Methods: Data from a population-based cross-sectional sample of 804 postmenopausal women over the age of 50 years old living in the city of Valencia (Spain) were used. The women were interviewed to identify the prev- alence of osteoporotic fracture risk factors and underwent a densitometry and a dorsolumbar spine X-ray. Results: The most prevalent risk factors were densitometric osteoporosis (31.7%), history of parental hip fracture (19.4%), hypoestrogenism (19%), and body mass index (BMI) ≥30 kg/m 2 (35.2%). After adjusting for all covariables, densitometric osteoporosis was associated with increased age [odds ratio (OR) 65–69 years : 2.84, 95% confidence interval (CI): 1.75–4.61; OR 70–74 years : 4.01, 95% CI: 2.47–6.52; OR 75+ years : 5.96, 95% CI: 3.27–10.87] and inversely associated with high BMI (OR 25.0–29.9 : 0.51, 95% CI: 0.34–0.76; OR ≥30 : 0.30, 95% CI: 0.19–0.46). Morphometric vertebral fracture was associated with age (OR 65–69 years : 2.04, 95% CI: 1.03–4.05; OR 70–74 years : 4.05, 95% CI: 2.11–7.77; OR 75+ years : 8.43, 95% CI: 3.97–17.93), poor educational level (OR: 1.70, 95% CI: 1.06–2.72) and with densitometric osteoporosis and BMI ≥30 kg/m 2 (OR: 3.35, 95% CI: 1.85–6.07). Conclusions: The most prevalent osteoporotic fracture risk factors were having a high BMI and the presence of densitometric osteoporosis. A higher risk of morphometric vertebral fracture in women with both low bone mineral density and high BMI was found. This association, if confirmed, has important implications for clinical practice and fracture risk tools. We also found a higher risk in women with a poor educational level. More attention should be addressed to these populations in order to control modifiable risk factors. © 2012 Elsevier Inc. All rights reserved. Introduction Osteoporosis is a multi-factorial skeletal disease characterized by low bone mass and a deterioration of the macro and microarchitecture of bone tissue, which leads to increased bone fragility and susceptibility to fracture. Osteoporosis is a silent disease, yet has a major clinical im- pact because of its association with an increased risk of fracture. Where- as hip fractures are the most serious and costly, vertebral fractures are the most common form of osteoporotic fractures, with population prev- alence estimates in Spain between 20% and 30% in post-menopausal women over the age of 50 years old [1,2]. Studies in other countries show figures between 35% and 50% [3–5], prevalence being highly dependent on the definition of vertebral fracture (clinical, morphomet- ric, radiological degree of deformity) and the sample used, as preva- lence increases with age, patients recruited in specialist clinics, and in patients with rheumatoid arthritis, lupus and other diseases. While fractures of the vertebrae are underdiagnosed and under- treated [6–8], they often occur earlier than hip fractures in disease pro- gression, and vertebral fractures are associated with an increased risk of both future vertebral and nonvertebral fractures [9–11]. Hence, 20% of women who have had a recent vertebral fracture will have a new frac- ture within a year [12]. Having had one or more vertebral fractures has been related to lower survival rates [13,14], and vertebral fracture also causes chronic back pain, limitations in daily living activities and poorer quality of life [15–17]. Today it is widely accepted that in addition to bone mineral density (BMD), several clinical risk factors are strongly related to osteoporotic fractures, and in recent years several risk assessment tools have been proposed for estimating the probability of osteoporotic fractures and Bone 52 (2013) 393–399 ⁎ Corresponding author at: Health Services Research Unit, Centro Superior de Investigación en Salud Pública (CSISP), Avda. de Cataluña 21, 46020 Valencia, Spain. E-mail address: sanfelix_gab@gva.es (G. Sanfélix-Gimeno). 8756-3282/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.bone.2012.10.022 Contents lists available at SciVerse ScienceDirect Bone journal homepage: www.elsevier.com/locate/bone