Estimate the prevalence of silent vertebral fractures and assess demographic and clinical predictors among UK Biobank adults aged 40–79 years without reported spinal fracture or trauma.
Approach:
Study population: Whole-spine DXA images and participant data were analysed for 2,446 eligible adults (mean age 62.0 years; 1,151 men).
Fracture assessment: An automated six-point morphometric algorithm was reviewed by a trained radiographer and independently verified by a musculoskeletal radiologist blinded to clinical information. Fractures with at least 25% vertebral height loss were classified as moderate or s…
Analysis: The study assessed prevalence and associations with participant characteristics using multivariable logistic regression; predictive performance was also examined with logistic regression and random forest models.
Key Findings:
Moderate or severe vertebral fractures were identified in 356 participants (14.6%).
Prevalence increased from 9.4% among participants aged 40–49 years to 19.6% among those aged 70–79 years.
Prevalence was higher in men than women (18.8% versus 10.8%).
Radiologist adjudication classified fractures as mild in 42.3%, moderate in 53.5%, and severe in 4.2%; including 20–24.9% deformities yielded an approximately 30% prevalence.
Interobserver agreement between radiologists was substantial (Fleiss’ κ = 0.74), while agreement between radiologist adjudication and the automated system was lower (κ = 0.31).
Interpretation:
In this UK Biobank imaging cohort, silent vertebral fractures were identified in 14.6% of participants using a threshold of at least 25% height loss. The authors report that degenerative changes and spinal shape variation contributed to automated false-positive classifications.
Limitations:
The analysis included 2,446 participants from the UK Biobank imaging cohort, rather than the full UK Biobank population.
The supplied context does not report the adjusted predictor estimates or the predictive-model performance results.
DXA image quality was inadequate for 220 of 32,058 vertebrae assessed.
