{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:44:47Z","timestamp":1775126687013,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Vertebral fractures are the most common osteoporotic fractures and are frequently underdiagnosed. Although prior fragility fractures increase the risk of subsequent fractures, the magnitude and distribution of extremity fracture risk following vertebral fractures remain incompletely defined. Objective: The objective of this study is to evaluate the risk of subsequent extremity fractures following vertebral fractures in adults aged \u226550 years and to characterize fracture patterns and timing. Methods: A systematic review was conducted using three databases (PubMed, OVID, and Scopus) covering studies published between January 2005 and December 2025. Studies reporting subsequent extremity fractures after an index vertebral fracture in adults aged \u226550 years were included. Data extraction included patient demographics, fracture characteristics, treatment variables, and incidence of subsequent fractures. Results: Eight studies were included in the qualitative (narrative) synthesis, comprising a total of 488,770 patients with an index vertebral fracture. The reported incidence of subsequent extremity fractures ranged from 1.4% to 12.4%, with a crude aggregated incidence of 6.90% (33,605 patients). Hip fractures accounted for 73.3% of extremity fractures, followed by forearm\/wrist (11.8%), humerus (10.3%), and ankle fractures (3.26%). Most subsequent extremity fractures occurred within 1\u20133 years after the index vertebral fracture. Additionally, 23,542 patients (4.82%) experienced subsequent vertebral fractures. Rates of dual-energy X-ray absorptiometry utilization and pharmacologic treatment ranged from 5% to 34.5%. Conclusions: Vertebral fractures in adults aged \u226550 years are strong predictors of subsequent extremity fractures, particularly hip fractures, with risk concentrated in the early post-fracture period. These findings support the concept of a systemic fracture cascade and emphasize the need for early detection and structured secondary prevention strategies.<\/jats:p>","DOI":"10.3390\/jcm15072596","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:22:36Z","timestamp":1774858956000},"page":"2596","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vertebral Fracture as a Predictor of Subsequent Extremity Fractures: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Yousif Qais","family":"Al-Khafaji","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-8657","authenticated-orcid":false,"given":"\u00c1rp\u00e1d","family":"Viola","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"},{"name":"Neurotraumatology Division, Semmelweis University, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siran","family":"Aslan","sequence":"additional","affiliation":[{"name":"Neurotraumatology Division, Semmelweis University, 1081 Budapest, Hungary"},{"name":"Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7939-447X","authenticated-orcid":false,"given":"Murtadha Qais","family":"Al-Khafaji","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Frimley Park Hospital, Frimley GU16 7UJ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad Abdul","family":"Al","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa Qais","family":"Al-Khafaji","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-7671","authenticated-orcid":false,"given":"Faris","family":"Ayasra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahad Qais","family":"Al-Khafaji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e1s","family":"Gati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"Foglar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"},{"name":"Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9239-0752","authenticated-orcid":false,"given":"Mohammad Walid","family":"Al-Smadi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dr. Manninger Jen\u0151 Traumatology Institute, 1081 Budapest, Hungary"},{"name":"Neurotraumatology Division, Semmelweis University, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3109\/13697137.2013.808182","article-title":"Impact of Osteoporosis and Bone Fracture on Health-Related Quality of Life in Postmenopausal Women","volume":"17","author":"Palacios","year":"2014","journal-title":"Climacteric"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s00198-012-2074-y","article-title":"European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women","volume":"24","author":"Kanis","year":"2013","journal-title":"Osteoporos. 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