Joint Associations of Prevalent Radiographic Vertebral Fracture and Abdominal Aortic Calcification With Incident Hip, Major Osteoporotic, and Clinical Vertebral Fractures

John T Schousboe, Lisa Langsetmo, Pawel Szulc, Joshua R. Lewis, Brent C. Taylor, Allyson M. Kats, Tien N Vo, Kristine E. Ensrud

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2 Scopus citations


Prevalent vertebral fractures (PVFx) and abdominal aortic calcification (AAC) are both associated with incident fractures and can be ascertained on the same lateral spine images, but their joint association with incident fractures is unclear. Our objective was to estimate the individual and joint associations of PVFx and AAC with incident major osteoporotic, hip, and clinical vertebral fractures in 5365 older men enrolled in the Osteoporotic Fractures in Men (MrOS) Study, using Cox proportional hazards and Fine and Gray subdistribution hazards models to account for competing mortality. PVFx (Genant SQ grade 2 or 3) and 24-point AAC score were ascertained on baseline lateral spine radiographs. Self-reports of incident fractures were solicited every 4 months and confirmed by review of clinical radiographic reports. Compared with men without PVFx and AAC-24 score 0 or 1, the subdistribution hazard ratio (SHR) for incident major osteoporotic fracture was 1.38 (95% confidence interval [CI] 1.13–1.69) among men with AAC-24 score ≥2 alone, 1.71 (95% CI 1.37–2.14) for men with PVFx alone, and 2.35 (95% CI 1.75–3.16) for men with both risk factors, after accounting for conventional risk factors and competing mortality. Wald statistics showed improved prediction model performance by including both risk factors compared with including only AAC (chi-square = 17.3, p <.001) or including only PVFx (chi-square = 8.5, p =.036). Older men with both PVFx and a high level of AAC are at higher risk of incident major osteoporotic fracture than men with either risk factor alone. Assessing prevalent radiographic vertebral fracture and AAC on the same lateral spine images may improve prediction of older men who will have an incident major osteoporotic fracture, even after accounting for traditional fracture risk factors and competing mortality.

Original languageEnglish (US)
Pages (from-to)892-900
Number of pages9
JournalJournal of Bone and Mineral Research
Issue number5
Early online dateMar 17 2021
StatePublished - May 2021

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. This article is also the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System. The funding agencies had no direct role in the conduct of the study; the collection, management, analyses, and interpretation of the data; or preparation or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the United States government. MrOS data are available to the public via the MrOS Online website ( Authors' roles: Study concept and design: JTS and KEE. Data collection: KEE. Data analysis and interpretation: JTS and LL. Drafting manuscript: JTS. Critical review and final approval of manuscript content: LL, PS, JRL, BCT, AMK, TNV, and KEE. LL performed the statistical analyses and is independent of any commercial funder. She had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses. Author contributions: JTS: Conceptualization; formal analysis; investigation; methodology; visualization; writing-original draft. LL: Formal analysis; validation; writing-review & editing. PS: Writing-review & editing. JRL: Writing-review & editing. BCT: Writing-review & editing. AMK: Writing-review & editing. TNV: Writing-review & editing. KEE: Conceptualization; funding acquisition; investigation; methodology; project administration; supervision; writing-review & editing.

Publisher Copyright:
© 2021 American Society for Bone and Mineral Research (ASBMR)




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