Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan; Department of Orthopaedic Surgery, JCHO Osaka Minato Central Hospital, Osaka, Japan.
Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
J Orthop Sci. 2023 May;28(3):536-542. doi: 10.1016/j.jos.2022.02.001. Epub 2022 Mar 2.
Most patients with acute osteoporotic vertebral fracture (AOVF) are successfully treated conservatively. However, the optimal management method and prognosis for multiple AOVFs are unclear. This study aimed to investigate the prevalence of multiple AOVFs and identify the associated risk factors.
This study enrolled 134 hospitalized patients (mean age 83 ± 7.6 years, 66% women) with AOVF treated conservatively between 2017 and 2020. The fractures were diagnosed by magnetic resonance imaging (MRI). The AOVFs were divided into two groups; single osteoporotic vertebral fractures (OVF) and domino OVFs (at least two OVFs). The adjacent vertebral Hounsfield unit values (HU) of the OVF and dual x-ray absorptiometry (DXA) of the lumbar spine or hip were used to evaluate the bone mineral density (BMD). Logistic regression analysis was performed to identify the risk factors for domino OVFs.
Domino OVFs were noted in 21 (15.7%) of 134 patients. There were 10 cases of adjacent level and 11 cases of remote level. The BMI (18.5 ± 4.2 vs. 21.2 ± 4.6, p = 0.025) and adjacent vertebral HU value of OVF (57.3 ± 17.5 vs. 76.6 ± 24.1, p = 0.008) were significantly lower in the domino OVFs group than in the single OVF group. Logistic regression analysis revealed the adjacent vertebral HU value of the OVF as an independent risk factor for domino OVFs, (odds ratios (OR) 0.96, p = 0.012). The domino OVF group had a significantly higher decline in gait ability (76% vs. 48%, p = 0.017).
The adjacent vertebral HU value of AOVF is a useful tool for evaluating BMD for domino OVFs. The optimal treatment for osteoporosis should be considered to prevent subsequent domino OVFs.
大多数急性骨质疏松性椎体骨折（AOVF）患者经保守治疗可获得良好疗效。然而，对于多发 AOVF 的最佳治疗方法和预后尚不清楚。本研究旨在探讨多发 AOVF 的发生率，并确定其相关的危险因素。
本研究纳入了 2017 年至 2020 年间接受保守治疗的 134 例 AOVF 住院患者（平均年龄 83±7.6 岁，66%为女性）。骨折由磁共振成像（MRI）诊断。将 AOVF 分为两组：单纯骨质疏松性椎体骨折（OVF）和多米诺 OVF（至少两个 OVF）。OVF 的相邻椎体 Hounsfield 单位值（HU）和腰椎或髋部双能 X 线吸收测定法（DXA）用于评估骨密度（BMD）。采用 logistic 回归分析确定多米诺 OVF 的危险因素。
134 例患者中，21 例（15.7%）发生多米诺 OVF。其中 10 例为相邻水平，11 例为远隔水平。多米诺 OVF 组的 BMI（18.5±4.2 与 21.2±4.6，p=0.025）和 OVF 的相邻椎体 HU 值（57.3±17.5 与 76.6±24.1，p=0.008）明显低于单纯 OVF 组。logistic 回归分析显示，OVF 的相邻椎体 HU 值是多米诺 OVF 的独立危险因素（比值比（OR）0.96，p=0.012）。多米诺 OVF 组的步态能力下降更为明显（76%与 48%，p=0.017）。
AOVF 的相邻椎体 HU 值是评估多米诺 OVF 骨密度的有用工具。应考虑对骨质疏松症进行最佳治疗，以预防后续的多米诺 OVF。
