Non-participants differ from participants as regards risk factors for vertebral deformities

Interpretation of data in epidemiological cohort studies may be confounded if differences exist between non-participants and participants. In the Malmo part of the European Vertebral Osteoporosis Study (EVOS), which was designed to evaluate the prevalence of vertebral deformity in 50-80-year-old persons, we compared 74 men and 95 women who had been invited, but declined to participate with age- and gender-matched participants as regards alcohol abuse, previous fractures and subsequent mortality, factors known to affect the prevalence of vertebral deformity. We found more men with alcohol abuse, more men with a previous fragility fracture and a tendency to more men with a previous clinical vertebral fracture among the non-participants than in the male partici- pants. In contrast, there were fewer female non-partici- pants than female participants with a previous clinical vertebral fracture. The mortality rate during the decade after the baseline examination was higher among both male and female non-participants. The "true" prevalence of vertebral deformity in the whole male population at risk in Malmo seems to be underestimated in the EVOS study. In women, it is more dife cult to estimate the combined result of the confounding factors. Conclusions based on the EVOS participants may not be applicable to the whole popula- tion at risk. n