259. Incidence of Lumbar Vertebral Fractures Based on Etiology Throughout the United States from 2010 to 2018

BACKGROUND CONTEXT Lumbar vertebral fractures are debilitating injuries that are widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. In addition to the negative clinical impact, vertebral fractures are also associated with a significant economic impact. Although there are several studies on the etiology of cervical spine fractures, there have been no publications in English language on the annual incidence and etiology of lumbar vertebral fractures to the authors’ knowledge. PURPOSE The purpose of this study is to investigate the most frequent annual etiologies of lumbar vertebral fractures presented to EDs throughout the U.S. from 2010 to 2018. STUDY DESIGN/SETTING Retrospective database analysis. PATIENT SAMPLE The NEISS database was used to identify all patients who visited participating emergency departments between 2010-2018 and were diagnosed with a lumbar spine fracture. OUTCOME MEASURES The study sought to quantify the incidence rates and national estimates, define the three most frequent etiologies of lumbar fracture, as well as to describe the mean age and sex of the study population. METHODS The national estimates of the three most frequent etiologies as well as mean age and sex were verified by utilizing algorithms provided by NEISS. The 95% confidence interval was calculated using a verified formula provided by the NEISS database. Population estimates by age (18+) were obtained from the U.S. Census and used to calculate annual incidence rates of lumbar fractures per 100,000 people. RESULTS The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010 to 2018 which is a 54% increase. Similarly, the incidence rates of each main etiology increased during the time frame studied. From 2010-2018, there were 382,914 (95% CI: 382,855-382,973) lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277-34,379) in 2010 to 57,098 (95% CI: 57,044-57,152) in 2018 - a 66.3% increase. Men composed 40.2% of the lumbar fractures, while women made up 59.8% of fractures. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38-65.62) to 68.4 from 2010-2018 (95% CI: 68.32-68.48), a 4.5% increase. For all investigated years, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. ANOVA regression analysis of total fractures, ladder-related fractures, mean age and stair-related fractures revealed the increase in annual vertebral fractures to be most statistically correlated to the increase in ladder-related fractures and increase in mean annual age (P<0.05 and significance F=.0008). CONCLUSIONS This investigation has shown that the volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and that much of this increase is accounted for by floor, stair/step and ladder-related injuries (48%). Considering that vertebral fractures may be as disabling as hip fractures highlights the need to address and lower the incidence per 100,000 of 22.5 of lumbar vertebral fractures in the U.S. This study provides insight into the most common causes of lumbar fractures, being floor, stair/step and ladder-related injuries, and the at-risk population, which were primarily women with a mean age of 68 years. The identification of lumbar fractures due to ladder-related injuries is a statistically significant driver of the increase in total fractures and can potentially play a powerful role in guiding prevention strategies for providers and inform caretakers of appropriate precautions. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Lumbar vertebral fractures are debilitating injuries that are widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. In addition to the negative clinical impact, vertebral fractures are also associated with a significant economic impact. Although there are several studies on the etiology of cervical spine fractures, there have been no publications in English language on the annual incidence and etiology of lumbar vertebral fractures to the authors’ knowledge. The purpose of this study is to investigate the most frequent annual etiologies of lumbar vertebral fractures presented to EDs throughout the U.S. from 2010 to 2018. Retrospective database analysis. The NEISS database was used to identify all patients who visited participating emergency departments between 2010-2018 and were diagnosed with a lumbar spine fracture. The study sought to quantify the incidence rates and national estimates, define the three most frequent etiologies of lumbar fracture, as well as to describe the mean age and sex of the study population. The national estimates of the three most frequent etiologies as well as mean age and sex were verified by utilizing algorithms provided by NEISS. The 95% confidence interval was calculated using a verified formula provided by the NEISS database. Population estimates by age (18+) were obtained from the U.S. Census and used to calculate annual incidence rates of lumbar fractures per 100,000 people. The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010 to 2018 which is a 54% increase. Similarly, the incidence rates of each main etiology increased during the time frame studied. From 2010-2018, there were 382,914 (95% CI: 382,855-382,973) lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277-34,379) in 2010 to 57,098 (95% CI: 57,044-57,152) in 2018 - a 66.3% increase. Men composed 40.2% of the lumbar fractures, while women made up 59.8% of fractures. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38-65.62) to 68.4 from 2010-2018 (95% CI: 68.32-68.48), a 4.5% increase. For all investigated years, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. ANOVA regression analysis of total fractures, ladder-related fractures, mean age and stair-related fractures revealed the increase in annual vertebral fractures to be most statistically correlated to the increase in ladder-related fractures and increase in mean annual age (P<0.05 and significance F=.0008). This investigation has shown that the volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and that much of this increase is accounted for by floor, stair/step and ladder-related injuries (48%). Considering that vertebral fractures may be as disabling as hip fractures highlights the need to address and lower the incidence per 100,000 of 22.5 of lumbar vertebral fractures in the U.S. This study provides insight into the most common causes of lumbar fractures, being floor, stair/step and ladder-related injuries, and the at-risk population, which were primarily women with a mean age of 68 years. The identification of lumbar fractures due to ladder-related injuries is a statistically significant driver of the increase in total fractures and can potentially play a powerful role in guiding prevention strategies for providers and inform caretakers of appropriate precautions.