Asahi Ryoma, Nakamura Yutaka, Koike Yoshinao, Kanai Masayoshi, Yuguchi Satoshi, Kamo Tomohiko, Azami Masato, Ogihara Hirofumi, Asano Satoshi
School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan.
Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan.
Eur Spine J. 2023 Apr;32(4):1446-1454. doi: 10.1007/s00586-023-07599-3. Epub 2023 Feb 21.
Determining the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures is essential for understanding fracture risk and informing clinicians and physical therapists. We determined the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures in this study.
In the retrospective cohort study, we enrolled a total of 255 women aged ≥ 65 years who visited an outpatient osteoporosis clinic. We measured participants' bone mineral density and sagittal alignment, including sagittal vertical axis (SVA), pelvic tilt, thoracic kyphosis, pelvic incidence, lumbar lordosis, global tilt, and gap score at the initial visit. The cut-off value for sagittal alignment that was significantly associated with fall-related fractures was calculated after using multivariate Cox proportional hazards regression analysis.
Ultimately, 192 patients were included in the analysis. After a mean follow-up of 3.0 years, 12.0% (n = 23) had fractures due to falls. Multivariate Cox regression analysis confirmed that SVA (hazard ratio [HR] = 1.022, 95% confidence interval [CI] = 1.005-1.039) was the only independent predictor of fall-related fracture occurrence. The predictive ability of SVA for the occurrence of fall-related fractures was moderate (area under the curve [AUC] = 0.728, 95% CI = 0.623-0.834), with a cut-off value of 100 mm for SVA. SVA classified by cut-off value was also associated with an increased risk of developing fall-related fractures (HR = 17.002, 95% CI = 4.102-70.475).
We found that assessing the cut-off value of sagittal alignment would be useful information in understanding fracture risk in postmenopausal older women.
确定矢状面排列的最佳截断值对于检测有跌倒相关骨折高风险的骨质疏松患者至关重要，这有助于了解骨折风险并为临床医生和物理治疗师提供信息。在本研究中，我们确定了用于检测有跌倒相关骨折高风险的骨质疏松患者的矢状面排列的最佳截断值。
在这项回顾性队列研究中，我们共纳入了255名年龄≥65岁且前往门诊骨质疏松诊所就诊的女性。我们在初次就诊时测量了参与者的骨密度和矢状面排列，包括矢状垂直轴（SVA）、骨盆倾斜度、胸椎后凸、骨盆入射角、腰椎前凸、整体倾斜度和间隙评分。在使用多变量Cox比例风险回归分析后，计算与跌倒相关骨折显著相关的矢状面排列的截断值。
最终，192名患者纳入分析。平均随访3.0年后，12.0%（n = 23）的患者因跌倒发生骨折。多变量Cox回归分析证实，SVA（风险比[HR]=1.022，95%置信区间[CI]=1.005 - 1.039）是跌倒相关骨折发生的唯一独立预测因素。SVA对跌倒相关骨折发生的预测能力中等（曲线下面积[AUC]=0.728，95%CI=0.623 - 0.834），SVA的截断值为100mm。按截断值分类的SVA也与跌倒相关骨折发生风险增加相关（HR = 17.002，95%CI = 4.102 - 70.475）。
我们发现评估矢状面排列的截断值对于了解绝经后老年女性的骨折风险将是有用的信息。
