Halperin Scott J, Dhodapkar Meera M, Moran Jay, Jeong Seongho, Grauer Jonathan N, Varthi Arya
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
Global Spine J. 2025 Mar;15(2):1318-1323. doi: 10.1177/21925682241238672. Epub 2024 Mar 28.
Retrospective cohort study.
Geriatric vertebral compression fractures are the most common fracture associated with osteoporosis. Using a large national database, the current study aimed to examine and characterize bracing trends for geriatric thoracic/lumbar compression fracture management.
The current study utilized the PearlDiver database from 2015-2021. Patients who suffered thoracic/lumbar compression fractures (fifth thoracic to the fifth lumbar vertebra [T5-L5]) were identified. Exclusion criteria included patients less than 65 years old or an indication of infection or neoplasm. Patients who received a brace within 90-days after the initial diagnosis of thoracic/lumbar compression fracture were abstracted and characterized overall and by fracture level. Multivariable logistic regression was performed to assess for correlation with bracing trends.
In total 290 388 patients met inclusion criteria and suffered a thoracic/lumbar compression fracture (greatest incidence at the thoracolumbar junction). Of these, bracing was only prescribed for 4263 (1.5%), with the greatest variance of 1.5% by level. Independent predictors of bracing were geographic region (relative to northeast, west WE odds ratio [OR] 1.31, Midwest OR 1.20), younger age (OR 1.27 per decade), female sex (OR 1.17), and ECI (OR 1.02 per 2-point increase) ( < .05 for each).
Overall, the current study examined over a quarter of a million patients who suffered a T5-L5 compression fractures and found that only 1.5% of patients were braced. This low percentage, and that greatest predictor for bracing was non-clinical (geographic region), highlight the inconsistency of this practice and may be useful for developing treatment algorithms.
回顾性队列研究。
老年椎体压缩性骨折是与骨质疏松症相关的最常见骨折。本研究利用一个大型国家数据库，旨在研究并描述老年胸腰椎压缩性骨折治疗中支具使用的趋势。
本研究使用了2015年至2021年的PearlDiver数据库。确定患有胸腰椎压缩性骨折（胸5至腰5椎体）的患者。排除标准包括年龄小于65岁或有感染或肿瘤迹象的患者。对在胸腰椎压缩性骨折初次诊断后90天内接受支具治疗的患者进行提取，并按总体情况和骨折部位进行特征描述。进行多变量逻辑回归以评估与支具使用趋势的相关性。
共有290388名患者符合纳入标准并患有胸腰椎压缩性骨折（胸腰交界区发病率最高）。其中，仅4263例（1.5%）使用了支具，各部位差异最大为1.5%。支具使用的独立预测因素包括地理区域（相对于东北部，西部优势比[OR]为1.31，中西部为1.20）、年龄较小（每十年OR为1.27）、女性（OR为1.17）和ECI（每增加2分OR为1.02）（各P<0.05）。
总体而言，本研究对超过25万名胸腰段压缩性骨折患者进行了研究，发现仅1.5%的患者使用了支具。这一低比例以及支具使用的最大预测因素为非临床因素（地理区域），凸显了这种治疗方法的不一致性，可能有助于制定治疗方案。
