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Kim, Yoon, Ahn, Lee, Kim, and Choi: Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures
Original Article

Journal of Korean Spine Surg 2015;22(4):146-152.

Published online: 21 December 2015

DOI: https://doi.org/10.4184/jkss.2015.22.4.146

Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures

Min-Wook Kim, M.D., Dae-Hyun Yoon, M.D., Sang-Ho Ahn, M.D., Ji-Won Lee, M.D., Cheol-Hwan Kim, M.D., Yong-Soo Choi, M.D.

Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea

Corresponding author: Dae-Hyun Yoon, M.D. Department of Orthopedic Surgery, Kwangju Christian Hospital, 37 Yanrim-ro, Nam-gu, Gwangju, 503-715, Korea TEL: +82-62-650-5064, FAX: +82-62-650-5066 E-mail: stemcellchoi@gmail.com

Received 25 April 201521 July 2015       Accepted 19 October 2015

Copyright © 2015 Korean Society of Spine Surgery

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

A retrospective study.

Objectives

To investigate the potential risk factors for subsequent vertebral fractures according to the treatment of primary vertebral fractures.

Summary of Literature Review

Many previous studies have been reported on bone mineral density, bone loss, and mechanical properties as risk factors for osteoporotic vertebral fractures. However, few studies have investigated subsequent osteoporotic vertebral fractures.

Materials and Methods

57 patients who had undergone followup magnetic resonance imaging (MRI) of the spine were divided into two groups depending on the development of subsequent vertebral fractures: the fracture group with 40 cases and the non-fracture group with 17 cases. The patients’ clinical and radiographic data including bone mineral density, medication for osteoporosis, body mass index, vertebroplasty of primary vertebral fractures, thoracic kyphotic angle and lumbar lordotic angle, fat infiltration of the back extensor muscle, and primary multiple fractures were examined.

Results

The subsequent new vertebral fractures occurred at a mean of 24 ± 19 months after primary osteoporotic vertebral fractures. Vertebroplasty for primary fractures was associated with a higher incidence of subsequent new vertebral fractures (p=0.001). There was a significant increase in fat infiltration of the back extensor muscle after the primary vertebral fractures in the fracture group (p=0.001). A multiple logistic regression analysis showed the significance of vertebroplasty (odds’ ratio: 4.623, 95% confidence interval: 1.145–18.699, p=0.031).

Conclusions

These results suggest that vertebroplasty for primary vertebral fractures and increased fat infiltration of the back extensor muscle could be risk factors related to the development of subsequent osteoporotic vertebral fractures.

Keywords: Vertebral fractures, Osteoporosis, Subsequent fractures, Back extensor muscle

REFERENCES

1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17:1726–33.
crossref
2. Melton LJ 3rd. Epidemiology worldwide. Endocrinol Metab Clin North Am. 2003; 32:1–13.
crossref
3. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001; 285:320–3.
crossref
4. Syed MI, Patel NA, Jan S, et al. New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR Am J Neuroradiol. 2005; 26:1601–4.
5. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000; 15:721–39.
crossref
6. Hayes WC, Piazza SJ, Zysset PK. Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin North Am. 1991; 29:1–18.
7. Hayes WC, Myers ER. Biomechanical considerations of hip and spine fractures in osteoporotic bone. Instr Course Lect. 1997; 46:431–8.
8. Myers ER, Wilson SE. Biomechanics of osteoporosis and vertebral fracture. Spine (Phila Pa 1976). 1997; 22(Suppl):25S–31S.
crossref
9. Lee JC, Cha JG, Kim Y, et al. Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine (Phila Pa 1976). 2008; 33:318–25.
10. Yuan HA, Brown CW, Phillips FM. Osteoporotic spinal deformity: a biomechanical rationale for the clinical conse-quences and treatment of vertebral body compression fractures. J Spinal Disord Tech. 2004; 17:236–42.
11. Zhang Z, Fan J, Ding Q, et al. Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty: a systematic review and meta-analysis. J Spinal Disord Tech. 2013; 26:E150–7.
12. Lin WC, Cheng TT, Lee YC, et al. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol. 2008; 19:225–31.
crossref
13. Lee WS, Sung KH, Jeong HT, et al. Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J. 2006; 15:1777–83.
crossref
14. Kim SH, Kang HS, Choi JA, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol. 2004; 45:440–5.
crossref
15. Moon ES, Kim HS, Park JO, et al. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved. Yonsei Med J. 2007; 48:645–52.
crossref
16. Berlemann U, Ferguson SJ, Nolte LP, et al. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br. 2002; 84:748–52.
17. Ma X, Xing D, Ma J, et al. Risk factors for new vertebral compression fractures after percutaneous vertebroplasty. Spine (Phila Pa 1976). 2013; 38:E713–22.
crossref
18. Sanfelix-Genoves J, Reig-Molla B, Sanfelix-Gimeno G, et al. The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study). Bone. 2010; 47:610–6.
crossref
19. Briggs AM, Greig AM, Wark JD, et al. A review of ana-tomical and mechanical factors affecting vertebral body integrity. Int J Med Sci. 2004; 1:170–80.
crossref
20. Cunha-Henriques S, Costa-Paiva L, Pinto-Neto AM, et al. Postmenopausal women with osteoporosis and muscu-loskeletal status: a comparative crosssectional study. J Clin Med Res. 2011; 3:168–76.
crossref
21. So KY, Kim DH, Choi DH, et al. The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures. Asian Spine J. 2013; 7:308–13.
crossref
22. Sinaki M, Wollan PC, Scott RW, et al. Can strong back extensors prevent vertebral fractures in women with osteoporosis? Mayo Clin Proc. 1996; 71:951–6.
crossref
23. Sinaki M, Itoi E, Wahner HW, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year followup of postmenopausal women. Bone. 2002; 30:836–41.
crossref
24. Nevitt MC, Thompson DE, Black DM, et al. Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med. 2000; 160:77–85.

Figures and Tables%

Fig. 1.
(A) An 80- years -old female patient with a primary L2 osteoporoti vertebral fracture., The paravertebral muscle sity was measured by using a pseudocoloring tool on the L3 axial image. Muscle densty: 1111.87 (74.6%)., In this case, vertebroplas-trformed. (B) After 18Eighteen months after the primary fracture, a subsequent L4 vertebral frcture occurred. The Pparavertebral muscle density was measured by ug the same method on atthe same level. The Mmuscle denity had decreased to: 924.01 (64.0%).
jkss-22-146f1.tif
Table 1.
Demographic Characteristics of the Study Subjects
Study Group (n=40) Control Group (n=17) p-value
Median age (yr) 71±8.4 70.3±7.7 0.474
Sex 0.031
Male 6 (15.0%) 7 (41.2%)
Female 34 (85.0%) 10 (58.8%)
Body mass index (Kg/m2) 23.1±3.4 23.1±2.53 0.935

Values are mean±standard deviation.

Table 2.
Baseline Characteristics of the Study Subjects
Characteristics Study Group (n=40) Control Group (n=17) p-value
Bone mineral density (T-score) -2.57±0.85 -2.41±0.72 0.761
Mean no. of VCFs at baseline (range) 1.23(1-3) 1.35(1-2) 0.423
Extensor muscle volume of L3 (mm2) 1980±643 1788±490 0.329
Muscle-fat infiltration ratio of L3 (%) 61.6±9.6 59.5±6.5 0.428
Kyphotic angle of T spine (°) 19.5±11.6 21.5±15.9 0.704
Lordortic angle of L spine (°) 40.7±14.8 42.7±13.4 0.669
Duration of osteoporosis medication 0.228
Continued (100%) 11(27.5%) 1(6%)
Intermittent (50-100%) 3(7.5%) 1(6%)
Rarely (<50%) 26(65%) 15(88%)
MRI F/U interval (months) 24±19.2 28.1±18.3 0.868

Values are mean±standard deviation.

Table 3.
Changes from Baseline to Final Follow up of Both Groups
Variables Study Group Control Group
1st 2nd P 1st 2nd P
Extensor muscle volume of L3 (mm2) 1980.8 1871.3 0.006* 1788.5 1605.1 <0.001*
Muscle-fat infiltration ratio of L3 (%) 61.6 57.72 0.001* 59.5 57.4 0.394
BMD (T-score) -2.57 -2.81 0.089 -2.41 -2.53 0.600
BMI (Kg/m2) 23.1 22.9 0.331 23.1 22.9 0.612
T-Kyphotic angle(°) 19.5 21.2 0.310 21.5 22.7 0.715
L-Lordortic angle (°) 40.7 39.6 0.401 42.7 41.5 0.381

∗ Significantly variables, 1 st means baseline, 2nd means final follow up.

Table 4.
Univariate Logistic Regression Analysis for New Vertebral Fracture
Variables B OR 95% Cl p-value
Primary factured age (yr) 0.023 1.024 0.955-1.096 0.509
Sex 1.378 4.325 1.082-14.533 0.038*
Primary multiple fracture 0.511 1.667 0.454-6.112 0.441
Vertebroplasty 2.148 10.201 2.293-32.015 0.001*
ΔBMD -0.900 0.995 0.069-2.381 0.318*
ΔBMI (Kg/m2) 0.002 0.995 0.723-1.389 0.986
ΔThoracic kyphosis (°) 0.017 1.018 0.946-1.095 0.641
ΔLumbar lordorsis (°) 0.002 1.003 0.934-1.076 0.940
ΔExtensor muscle of L3 (mm2) 0.001 1.054 0.998-1.004 0.304*
ΔExtensor muscle of L3 (%) -0.044 0.911 0.867-1.055 0.378

Δ: Changed variables during follow up, B: regression coefficient, OR: odds ratio, Cl: Confidence interval.

∗ Included in the multiple logistic model.

Table 5.
Multiple Logistic Regression Analysis for New Vertebral Fracture
Variables B OR 95% Cl p-value
Vertebroplasty 1.532 4.623 1.145-18.699 0.031
Sex (Female) 1.144 2.221 0.697-14.142 0.136
ΔExtensor muscle of L3 (mm2) 0.003 1.846 0.998-1.008 0.174
ΔBMD -0.589 0.207 0.05-6.448 0.648

Δ: Changed variables during follow up, B: regression coefficient, OR: odds ratio, Cl: Confidence interval.

∗ Significantly variables.

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