Risk Factors for the Progressive Osteoporotic Spinal Fracture

Jong-Min Sohn; Ki-Won Kim; Kee-Yong Ha; Nan-Kyoung Ha; Young-Hoon Kim; Ju-Hwan Kim

doi:10.4184/jkss.2009.16.3.153

Journal List > J Korean Soc Spine Surg > v.16(3) > 1035847

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Sohn, Kim, Ha, Ha, Kim, and Kim: Risk Factors for the Progressive Osteoporotic Spinal Fracture

Original Article

Journal of Korean Spine Surg 2009;16(3):153-159.

Published online: 21 February 2009

DOI: https://doi.org/10.4184/jkss.2009.16.3.153

Risk Factors for the Progressive Osteoporotic Spinal Fracture

Jong-Min Sohn, M.D., Ki-Won Kim, M.D.^∗, Kee-Yong Ha, M.D.^#, Nan-Kyoung Ha, M.D., Young-Hoon Kim, M.D., Ju-Hwan Kim, M.D.

^∗Department of Orthopedic Surgery, Incheon St. Mary's Hospital, St. Mary's Hospital, The Catholic University of Korea

^#Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea

Address reprint requests to Young-Hoon Kim, M.D. Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea. #665-8, Bupyeong-6Dong, Bupyeong-Gu, Incheon, 403-720, Korea Tel: 82-32-510-5512 Fax: 82-32-505-7795 E-mail: boscoa@empal.com

Received 6 January 2009 Accepted 29 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective risk-factor analysis

Objectives

This study investigated the clinical and radiological risk factors associated with the progression of osteoporotic spinal fractures (OSFs) after conservative treatment.

Summary of Literature Review

Nonunion and cleft signs on radiographs are strongly associated with complicated osteoporotic spinal fractures.

Materials and Methods

From Jan. 2005 to Dec. 2007, 84 patients (15 males and 69 females; mean 72.6 yrs) were enrolled in this retrospective review. The progressive OSF, clinical and radiological factors were analyzed considering the progression of the kyphotic angle (PKA>20°) and the presence of intravertebral cleft signs (IVC). Age, gender, body mass index, vertebral level involved, BMD score, MRI classification and initial kyphotic angle were adopted for the analysis. For statistical analysis, a chi-square test was performed to analyze the relationship between each factor and multiple logistic regression analysis was performed to analyze the multifactorial explanatory factor.

Results

The presence of IVC was related to the thoracolumbar fracture, midportion MR classification and high body mass index. PKA>20°was related to the thoracolumbar fracture and midportion classification. For multifactorial analysis using these seven factors, two factors (the level of fracture and MR classification) were found to be associated with the presence of IVC with statistical significance. In the thoracolumbar fracture, the incidence of IVC was 5.2 times higher than the other levels. The incidence of IVC in endplate classification was 16% lower than in the midportion.

Conclusion

BMI, the fracture level involved and MR classification were associated with the development of IVC and PKA>20° for a conservative treatment of OSF. Multiple logistic analysis revealed the level of the fracture and MR classification to be significant.

Keywords: Keyword, Osteoporosis, Spinal fracture, Nonunion, Risk factors

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Figures and Tables%

Fig. 1.

A case of complicated osteoporotic compression fracture. A 65-year-old woman suffered from intractable back and flank pain and progressive weakness of the lower extremities. She underwent anterior decompression and fusion surgery.

Fig. 2.

MRI characteristics of osteoporotic compression fracture. (A) The cases with findings of signal change around the endplate and disruption of endplate are classified as an endplate type. (B) The cases with findings of signal change at the midportion of vertebral body and disruption of anterior cortex are classified as a midportion type.

Table 1.

Baseline characteristics of all the patients enrolled

Characteristics	IVC			PKA
Characteristics	IVC (+) N=21	IVC (-) N=63	P value^*	PKA>20° N=44	PKA<20° N=40	P value^*
Age			.438			.818
Under 50	1	0		1	0
51~60	2	6		4	4
61~70	9	19		14	14
71~80	5	20		14	11
81~90	4	17		10	11
Over 90	0	1		1	0
Sex			.869			.625
남자	4	11		7	8
여자	17	52		37	32
BMI			.001^*			.531
BMI>23.0	21	24	OR 1.88 (95% CI 1.42-2.46)	25	20
BMI<23.0	0	39		19	20
BMD (lowest T-score)			.645			.461
-1.0 ~ -1.9	0	5		3	2
-2.0 ~ -2.9	3	13		5	11
-3.0 ~ -3.9	8	21		17	12
-4.0 ~ -4.9	7	16		13	10
Low than -5.0	3	8		6	5
Level			.003^*			.015^*
Thoracic	1	12		4	9
Thoracolumbar	17	24		28	13
lumbar	3	27		12	18
MRI Classification			.003^*			.018^*
Endplate	3	32		13	22
Mid-portion	18	31	OR 6.19 (95% CI 1.657-23.1)	31	18	OR 2.915 (95% CI 1.187-7.158)
Initial KA			.310			.571
Less than 20°	11	44		28	27
More than 20°	10	19		16	13

^∗ : The Chi-square test was used for analyzing odds ratio and p<0.05 means a statistical significance.

Table 2.

Results obtained from analysis for multiple accessed factors

	IVC			PKA
	Exp(B)	95% CI	P value^*	Exp(B)	95% CI	P value^*
Level of fracture	5.210	1.077~25.212	0.04	2.547	0.912~7.211	0.07
MRI Class	0.158	0.33~0.746	0.02	0.396	0.152~1.034	0.059

^∗ ; Logistic regression analysis (backward) was used for assessment of 7 clinical and radiological factors.

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