Osteoporosis International

, Volume 30, Issue 3, pp 555–563 | Cite as

Vertebral fractures cascade: potential causes and risk factors

  • H. CheEmail author
  • V. Breuil
  • B. Cortet
  • J. Paccou
  • T. Thomas
  • L. Chapuis
  • F. Debiais
  • N. Mehsen-Cetre
  • R.M. Javier
  • S. Loiseau Peres
  • C. Roux
  • K. Briot
Original Article



We performed a study to identify potential causes and risk factors of vertebral fracture cascade. Vertebral fracture cascade is a severe clinical event in patients with bone fragility. Only half of patients have an identified cause of secondary osteoporosis.


Vertebral fracture (VF) is the most common osteoporotic fracture, and a strong risk factor of subsequent VFs leading to VF cascade (VFC). We prompted a study to identify potential causes and risk factors of VFC.


VFC observations were collected retrospectively between January 2016 and April 2017. VFC was defined as an occurrence of at least three VFs within 1 year.


We included in 10 centers a total of 113 patients with VFC (79.6% of women, median age 73, median number of VFs in the cascade, 5). We observed 40.5% and 30.9% of patients with previous major fractures and a previous VF, respectively, and 68.6% with densitometric osteoporosis; 18.9% of patients were currently receiving oral glucocorticoids and 37.1% in the past.

VFC was attributed by the physician to postmenopausal osteoporosis in 54% of patients. A secondary osteoporosis associated with the VFC was diagnosed in 52 patients: glucocorticoid-induced osteoporosis (25.7%), non-malignant hemopathies (6.2%), alcoholism (4.4%), use of aromatase inhibitors (3.6%), primary hyperparathyroidism (2.7%), hypercorticism (2.7%), anorexia nervosa (2.7%), and pregnancy and lactation-associated osteoporosis (1.8%). A total of 11.8% of cases were reported following a vertebroplasty procedure. A total of 31.5% patients previously received an anti-osteoporotic treatment. In six patients, VFC occurred early after discontinuation of an anti-osteoporotic treatment, in the year after the last dose effect was depleted: five after denosumab and one after odanacatib.


The results of this retrospective study showed that only half of VFC occurred in patients with a secondary cause of osteoporosis. Prospective studies are needed to further explore the determinants of this severe complication of osteoporosis.


Cascade Osteoporosis Risks factors Vertebral fractures 


Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

Dr. Breuil received grant support and lecture fees from Amgen, Novartis, Chugai, and Lilly. Dr. Briot has received research grants or honoraria from Amgen, Lilly, Medtronic, and MSD. Dr. Cortet has received research grants or honoraria from Amgen, Expanscience, Ferring, Lilly, Medtronic, MSD, Mylan, Novartis, Roche diagnostics, Théramex, and UCB. Dr. Thomas received grant support, lecture fees, and consulting fees from Amgen, Merck Sharp & Dohme, and UCB Pharma; grant support and lecture fees from Chugai and Pfizer; consulting fees from Expanscience, Gilead Sciences, LCA, Thuasne, and Medac; grant support and consulting fees from HAC Pharma; grant support from Novartis; lecture fees from AbbVie, Biogen, and Bristol-Myers Squibb; and lecture fees and consulting fees from Eli Lilly and Teva Pharmaceutical Industries. Dr. Roux has received grants and/or honoraria from Alexion, Amgen, MSD, UCB. Dr. Che, Dr. Paccou, Dr. Chapuis, Dr. Debiais, Dr. Mehsen-Cetre, Dr. Javier, and Dr. Loiseau Peres have no disclosure to declare.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • H. Che
    • 1
    Email author
  • V. Breuil
    • 2
  • B. Cortet
    • 3
  • J. Paccou
    • 3
  • T. Thomas
    • 4
  • L. Chapuis
    • 5
  • F. Debiais
    • 6
  • N. Mehsen-Cetre
    • 7
  • R.M. Javier
    • 8
  • S. Loiseau Peres
    • 9
  • C. Roux
    • 10
  • K. Briot
    • 10
  1. 1.Rheumatology DepartmentCHU Lapeyronie MontpellierMontpellierFrance
  2. 2.Department of Rheumatology, BIAM - UMR E 4320 TIRO-MATOs CEA/UNSUniversité Côte D’Azur, Centre Hospitalier Universitaire NiceNiceFrance
  3. 3.Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d’OpaleLilleFrance
  4. 4.Rheumatology Department, CHU de Saint Etienne, INSERM U1059, Lab Biologie Intégrée du Tissu OsseuxUniversité de LyonSaint-Etienne Cedex 2France
  5. 5.Rheumatology DepartmentCH Simone Veil du VitreVitreFrance
  6. 6.Rheumatology DepartmentCHU La Miletrie PoitiersPoitiers CedexFrance
  7. 7.Rheumatology DepartmentCHU Pellegrin BordeauxBordeauxFrance
  8. 8.Rheumatology DepartmentHôpitaux Universitaires de StrasbourgStrasbourgFrance
  9. 9.Rheumatology DepartmentCHR OrléansOrleansFrance
  10. 10.Rheumatology Department, INSERM 1153, CHU Paris CochinParis Descartes UniversityParisFrance

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