Mortality from vertebral fractures in White women aged 65+ with osteoporosis: a CDC database trend analysis from 1999 to 2020

Abstract Osteoporotic vertebral fractures represent a significant yet underdiagnosed manifestation of osteoporosis, particularly affecting older White women. While vertebral fractures are among the most common osteoporotic fractures, their contribution to mortality has received less attention compared to hip fractures, creating a critical knowledge gap. This study analyzed temporal trends in age-adjusted mortality rates from osteoporotic vertebral fractures among White women aged 65 and older in the United States from 1999 to 2020. We conducted a retrospective analysis using Centers for Disease Control and Prevention’s Multiple Cause of Death files, identifying cases where both vertebral fractures and osteoporosis were listed as causes of death using specific ICD-10 codes. Age-adjusted mortality rates per 100 000 population were calculated using the 2000 US standard population, and joinpoint regression analysis identified significant changes in mortality trends over the 22-yr study period. Our findings revealed a concerning 87.5% increase in age-adjusted mortality rates, rising from 0.24 per 100 000 in 1999 to 0.45 per 100 000 in 2020. Joinpoint regression identified three distinct trend segments: a non-significant decline from 1999 to 2004, followed by a statistically significant increase from 2004 to 2009 with an annual percent change (APC) of 13.93%, and a more modest upward trend from 2009 to 2020. The overall average APC was 4.21%, indicating a highly significant upward trend in mortality rates. The pronounced increase during 2004-2009 coincides with important developments in osteoporosis management, including declining hormone replacement therapy use following Women’s Health Initiative findings and emerging bisphosphonate safety concerns. These findings underscore vertebral fractures as potentially life-threatening complications requiring aggressive prevention and management strategies. As the population ages, our results highlight the urgent need for improved osteoporosis screening, enhanced fracture risk assessment, and optimized treatment approaches to reduce the growing burden of vertebral fracture-related mortality in this vulnerable population.