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<i>Summary</i> <p>Vertebral fragility fractures (VFFs) are underdiagnosed despite increasing future fracture risk. In 307 hip fragility fracture patients, 28.0% had prior radiological VFFs—mostly severe, lumbar, and wedge-type—yet only 11.6% were diagnosed. This under-recognition underscores the importance of early VFFs detection to improve outcomes and prevent further fragility fractures.</p> Purpose <p>Vertebral fragility fractures (VFFs) are the most common osteoporotic fractures but are often undiagnosed. Despite the frequent absence of pain, VFFs are linked to increased morbidity and a higher risk of future fractures, including hip fractures. The purpose of this study was to determine the prevalence, location, type, and severity of previous VFFs in patients presenting with hip fragility fractures.</p> Methods <p>We conducted a retrospective study of patients aged ≥ 50&#xa0;years with hip fragility fractures admitted to our FLS between 2019 and 2023. Inclusion criteria required the availability of thoracic and/or lumbar spine imaging performed within the previous five years. Clinical data, lifestyle factors, and FRAX scores were collected. Spine images were independently assessed by two blinded reviewers using <i>Genant’s</i> semiquantitative method.</p> Results <p>Of 357 patients screened, 307 met inclusion criteria. The mean age was 80.9 ± 9.1&#xa0;years, and 84.0% were women. Radiological VFFs were present in 28.0% of patients, yet only 11.6% had a prior diagnosis. The lumbar (41.9%) and thoracic spine (31.4%) were the most frequently affected regions. Wedge-type fractures were most common (72.9%), and 62.8% were classified as severe. Patients with VFFs were significantly older (<i>p</i> = 0.007) and had higher FRAX scores (<i>p</i> &lt; 0.001). The odds of having VFFs were 2.17 and 2.07 times higher in patients with previous fractures and in those receiving antidepressant therapy, respectively.</p> Conclusions <p>Over one-fourth of patients with hip fractures have previous VFFs, though only a small portion have been officially diagnosed. These findings underscore the high prevalence and frequent under-recognition of VFFs.</p>

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The hidden fracture: a retrospective study of fragility vertebral fracture in patients with hip fracture

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Inês Genrinho,
  • Cátia Machado,
  • Alina Humenyuk,
  • Nuno Pais,
  • Anabela Barcelos

摘要

Summary

Vertebral fragility fractures (VFFs) are underdiagnosed despite increasing future fracture risk. In 307 hip fragility fracture patients, 28.0% had prior radiological VFFs—mostly severe, lumbar, and wedge-type—yet only 11.6% were diagnosed. This under-recognition underscores the importance of early VFFs detection to improve outcomes and prevent further fragility fractures.

Purpose

Vertebral fragility fractures (VFFs) are the most common osteoporotic fractures but are often undiagnosed. Despite the frequent absence of pain, VFFs are linked to increased morbidity and a higher risk of future fractures, including hip fractures. The purpose of this study was to determine the prevalence, location, type, and severity of previous VFFs in patients presenting with hip fragility fractures.

Methods

We conducted a retrospective study of patients aged ≥ 50 years with hip fragility fractures admitted to our FLS between 2019 and 2023. Inclusion criteria required the availability of thoracic and/or lumbar spine imaging performed within the previous five years. Clinical data, lifestyle factors, and FRAX scores were collected. Spine images were independently assessed by two blinded reviewers using Genant’s semiquantitative method.

Results

Of 357 patients screened, 307 met inclusion criteria. The mean age was 80.9 ± 9.1 years, and 84.0% were women. Radiological VFFs were present in 28.0% of patients, yet only 11.6% had a prior diagnosis. The lumbar (41.9%) and thoracic spine (31.4%) were the most frequently affected regions. Wedge-type fractures were most common (72.9%), and 62.8% were classified as severe. Patients with VFFs were significantly older (p = 0.007) and had higher FRAX scores (p < 0.001). The odds of having VFFs were 2.17 and 2.07 times higher in patients with previous fractures and in those receiving antidepressant therapy, respectively.

Conclusions

Over one-fourth of patients with hip fractures have previous VFFs, though only a small portion have been officially diagnosed. These findings underscore the high prevalence and frequent under-recognition of VFFs.