Liang Cheng-Loong, Wang Hao-Kwan, Syu Fei-Kai, Wang Kuo-Wei, Lu Kang, Liliang Po-Chou
Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
Department of Pharmacy, China Medical University Hospital, Taichung City, Taiwan.
Clin Interv Aging. 2015 Mar 27;10:635-42. doi: 10.2147/CIA.S80668. eCollection 2015.
Postvertebral augmentation vertebral compression fractures are common; repeated vertebral augmentation is usually performed for prompt pain relief. This study aimed to evaluate the incidence and risk factors of repeat vertebral augmentation.
We performed a retrospective, nationwide, population-based longitudinal observation study, using the National Health Insurance Research Database (NHIRD) of Taiwan. All patients who received vertebral augmentation for vertebral compression fractures were evaluated. The collected data included patient characteristics (demographics, comorbidities, and medication exposure) and repeat vertebral augmentation. Kaplan-Meier and stratified Cox proportional hazard regressions were performed for analyses.
The overall incidence of repeat vertebral augmentation was 11.3% during the follow-up until 2010. Patients with the following characteristics were at greater risk for repeat vertebral augmentation: female sex (AOR=1.24; 95% confidence interval [CI]: 1.10-2.36), advanced age (AOR=1.60; 95% CI: 1.32-2.08), diabetes mellitus (AOR=4.31; 95% CI: 4.05-5.88), cerebrovascular disease (AOR=4.09; 95% CI: 3.44-5.76), dementia (AOR=1.97; 95% CI: 1.69-2.33), blindness or low vision (AOR=3.72; 95% CI: 2.32-3.95), hypertension (AOR=2.58; 95% CI: 2.35-3.47), and hyperlipidemia (AOR=2.09; 95% CI: 1.67-2.22). Patients taking calcium/vitamin D (AOR=2.98; 95% CI: 1.83-3.93), bisphosphonates (AOR=2.11; 95% CI: 1.26-2.61), or calcitonin (AOR=4.59; 95% CI: 3.40-5.77) were less likely to undergo repeat vertebral augmentation; however, those taking steroids (AOR=7.28; 95% CI: 6.32-8.08), acetaminophen (AOR=3.54; 95% CI: 2.75-4.83), or nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR=6.14; 95% CI: 5.08-7.41) were more likely to undergo repeat vertebral augmentation.
We conclude that the incidence of repeat vertebral augmentation is rather high. An understanding of risk factors predicting repeat vertebral augmentation provides valuable basis to improve health care for geriatric populations.
椎体后凸成形术后椎体压缩骨折很常见；通常会进行重复椎体增强术以迅速缓解疼痛。本研究旨在评估重复椎体增强术的发生率及危险因素。
我们利用台湾地区国民健康保险研究数据库（NHIRD）进行了一项全国性、基于人群的回顾性纵向观察研究。对所有因椎体压缩骨折接受椎体增强术的患者进行评估。收集的数据包括患者特征（人口统计学、合并症和药物暴露情况）以及重复椎体增强术情况。采用Kaplan-Meier法和分层Cox比例风险回归进行分析。
截至2010年随访期间，重复椎体增强术的总体发生率为11.3%。具有以下特征的患者进行重复椎体增强术的风险更高：女性（比值比[AOR]=1.24；95%置信区间[CI]：1.10 - 2.36）、高龄（AOR=1.60；95% CI：1.32 - 2.08）、糖尿病（AOR=4.31；95% CI：4.05 - 5.88）、脑血管疾病（AOR=4.09；95% CI：3.44 - 5.76）、痴呆（AOR=1.97；95% CI：1.69 - 2.33）、失明或视力低下（AOR=3.72；95% CI：2.32 - 3.95）、高血压（AOR=2.58；95% CI：2.35 - 3.47）和高脂血症（AOR=2.09；95% CI：1.67 - 2.22）。服用钙/维生素D（AOR=2.98；95% CI：1.83 - 3.93）、双膦酸盐类药物（AOR=2.11；95% CI：1.26 - 2.61）或降钙素（AOR=4.59；95% CI：3.40 - 5.77）的患者进行重复椎体增强术的可能性较小；然而，服用类固醇（AOR=7.28；95% CI：6.32 - 8.08）、对乙酰氨基酚（AOR=3.54；95% CI：2.75 - 4.83）或非甾体类抗炎药（NSAIDs）（AOR=6.14；95% CI：5.08 - 7.41） 的患者进行重复椎体增强术的可能性更大。
我们得出结论，重复椎体增强术的发生率相当高。了解预测重复椎体增强术的危险因素可为改善老年人群的医疗保健提供有价值的依据。
