Prevalence and Predictors of Silent Vertebral Compression Fractures: A Cross-Sectional Population-Based Study Using UK Biobank Imaging Data

ObjectivesTo estimate the prevalence of silent vertebral compression fractures (VCF) in an asymptomatic population and to assess the demographic and clinical predictors using data from the UK Biobank. DesignA cross-sectional study using artificial intelligence-assisted six-point morphometry of dual-energy x-ray absorptiometry spine images. SettingUK Biobank imaging study at Stockport clinical research facility. Participants2 446 asymptomatic volunteers aged 40 to 79 years with no history of spinal trauma or vertebral fracture. Main outcome measuresVCFs were defined as greater than or equal to20 percent height loss, measured by artificial intelligence, with manual correction of annotations and confirmation by a musculoskeletal radiologist. Association with age, sex, bone mineral density, body mass index, and back pain were analysed. ResultsOf 2 446 participants, 763 (31.1 percent) had at least one vertebra with > 20 percent height loss. Fracture prevalence increased with age: 26.8 percent (37 of 138) in those aged 40-49 years, 26.1 percent (196 of 752) at 50-59 years, 33.0 percent (380 of 1 153) at 60-69 years, and 37.2 percent (150 of 403) at 70-79 years. Excluding mild deformities, 18 percent of those aged 40-49 years had moderate or severe fractures (> 25 percent height loss). Fractures were 11.5 percent more common in men than in women. Age was a significant predictor, but bone mineral density (BMD) and body-mass index (BMI) were not. Predictive models showed limited performance (sensitivity 44.4 percent, specificity 68.2 percent). Interobserver agreement was substantial (Fleiss kappa = 0.74). ConclusionsSilent VCFs are frequent by midlife, including among younger adults with normal bone density. Men are affected more often than women, and conventional risk factors inadequately identify those at risk. Earlier detection through opportunistic or population imaging may enable timely intervention and inform future screening and fracture-prevention strategies. Key messagesO_LIWhat is already known on this topic VCFs are common but often unrecognised, particularly when asymptomatic. Most evidence is derived from older or symptomatic populations. C_LIO_LIWhat this study adds Silent VCFs affect more than 30 percent of adults and over one-quarter of those under 50. They are more frequent in men and often occur despite normal bone mineral density. Conventional risk factors show limited predictive value. C_LIO_LIHow this study might affect research, practice or policy Expanding fracture assessment to younger populations could enable earlier intervention and inform future screening guidelines. C_LI Manuscript