Prevalence and predictors of silent vertebral compression fractures using DXA: a UK Biobank Imaging Study
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Published online version
Author(s)
Type
Journal Article
Abstract
Objectives
Silent vertebral fractures are common but under-recognised. We aimed to estimate the prevalence in an asymptomatic population and to identify demographic and clinical predictors using the UK Biobank data.
Materials and Methods
DXA spine images from 2,446 asymptomatic UK Biobank participants aged 40–79 years were analysed retrospectively. Vertebral fractures were defined as moderate or severe deformities (≥25% vertebral height loss). Fractures were identified using an artificial-intelligence assisted six-point morphometric algorithm with manual correction and radiologist confirmation. Associations with age, sex, bone mineral density (BMD), body mass index (BMI), medication and back pain were analysed.
Results
A total of 2,446 participants (mean age 62.0 ± 7.4 years; 1,151 men) were analysed. Moderate or severe vertebral fractures were identified in 356 participants (14.6%). Prevalence increased with age, from 9.4% in participants aged 40–49 years to 19.6% in those aged 70–79 years. Fractures were more common in men than women (18.8% vs 10.8%; adjusted OR 0.51 for women vs men, 95% CI 0.40–0.66; p < 0.001). BMD and most conventional clinical risk factors had limited predictive value.
Conclusions
Silent vertebral fractures are common in midlife, frequently occur in individuals with normal bone density, and are more prevalent in men. Conventional clinical risk factors have limited ability to identify affected individuals.
Silent vertebral fractures are common but under-recognised. We aimed to estimate the prevalence in an asymptomatic population and to identify demographic and clinical predictors using the UK Biobank data.
Materials and Methods
DXA spine images from 2,446 asymptomatic UK Biobank participants aged 40–79 years were analysed retrospectively. Vertebral fractures were defined as moderate or severe deformities (≥25% vertebral height loss). Fractures were identified using an artificial-intelligence assisted six-point morphometric algorithm with manual correction and radiologist confirmation. Associations with age, sex, bone mineral density (BMD), body mass index (BMI), medication and back pain were analysed.
Results
A total of 2,446 participants (mean age 62.0 ± 7.4 years; 1,151 men) were analysed. Moderate or severe vertebral fractures were identified in 356 participants (14.6%). Prevalence increased with age, from 9.4% in participants aged 40–49 years to 19.6% in those aged 70–79 years. Fractures were more common in men than women (18.8% vs 10.8%; adjusted OR 0.51 for women vs men, 95% CI 0.40–0.66; p < 0.001). BMD and most conventional clinical risk factors had limited predictive value.
Conclusions
Silent vertebral fractures are common in midlife, frequently occur in individuals with normal bone density, and are more prevalent in men. Conventional clinical risk factors have limited ability to identify affected individuals.
Date Issued
2026-10-13
Date Acceptance
2026-09-13
Citation
European Radiology, 2026
ISSN
0938-7994
Publisher
Springer
Journal / Book Title
European Radiology
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/.
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Subjects
Bone Density
Diagnostic Imaging
Fractures, Compression
Osteoporosis
Publication Status
Published online
Coverage Spatial
United Kingdom
Date Publish Online
2026-10-13