What are the risk factors for a second osteoporotic vertebral compression fracture?

Sang Hoon Hwang; Pyung Goo Cho; Kyoung-Tae Kim; Keung Nyun Kim; Sang Hyun Kim; Sung Hyun Noh

doi:10.1016/j.spinee.2023.07.010

What are the risk factors for a second osteoporotic vertebral compression fracture?

Spine J. 2023 Nov;23(11):1586-1592. doi: 10.1016/j.spinee.2023.07.010. Epub 2023 Jul 20.

Authors

Sang Hoon Hwang¹, Pyung Goo Cho¹, Kyoung-Tae Kim², Keung Nyun Kim³, Sang Hyun Kim¹, Sung Hyun Noh⁴

Affiliations

¹ Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
² Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
³ Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea; Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁴ Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea; Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. Electronic address: ulove07@ajou.ac.kr.

PMID: 37479141
DOI: 10.1016/j.spinee.2023.07.010

Abstract

Background context: Osteoporosis is characterized by decreased bone strength and an increased risk of fracture. Osteoporosis-related fractures are associated with increased morbidity, mortality, dysfunction, access to health care, health-care costs, and reduced quality of life. Therefore, preventing osteoporotic vertebral compression fractures (OVCF) is important. Secondary OVCFs often occur after the first OVCF.

Purpose: This study aimed to identify risk factors for a second OVCF after a first OVCF.

Study design: Retrospective observational study.

Patient sample: One hundred seventy-eight patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019 were enrolled in this study.

Outcome measures: The following data were observed for all cases: patient demographics, bone mineral density, and pelvic parameters.

Methods: We retrospectively reviewed patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019. Demographic factors, medication (oral bisphosphonate, zoledronic acid, denosumab), bone mineral density (BMD), body mass index (BMI), fat, and muscle amount of the trunk using dual-energy X-ray absorptiometry (DEXA), and pelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence minus lumbar lordosis) were investigated.

Results: Of 178 patients who had an OVCF, 68 (38.2%) had a second OVCF. Patients were followed up for >2 years and wore braces for an average of 6 months. The mean age was 71.9±8.63 years, mean BMD T-score was -3.1±1.09, and mean BMI was 23.3±2.96. Comparing those with and without a second OVCF, the smaller the BMD T-score and trunk muscle mass to fat ratio, the more likely a second OVCF occurred (p<.05). There were fewer second OVCF cases in the injection medication group than in the peroral group (p<.05). There were no significant differences in radiologic parameters between these groups.

Conclusions: Patients who had a second OVCF had an average of 21.3 months after the first OVCF. Risk factors for a second OVCF are low T-scores in the femur, and low M/F ratio of the trunk, android, and gynoid regions. For patients with an OVCF, injection medications may be advisable.

Keywords: Android; BMD; Gynoid; Osteoporosis medications; Osteoporotic vertebral compression fracture; Trunk.