Asahi Ryoma, Nakamura Yutaka, Kanai Masayoshi, Maruya Kohei, Asano Satoshi
Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Japan.
Saitama Spine Center, Higashi Saitama General Hospital, Satte, Japan.
Spine Surg Relat Res. 2024 Dec 10;9(3):350-357. doi: 10.22603/ssrr.2024-0248. eCollection 2025 May 27.
Spinal alignment in women with osteoporosis tends to deteriorate with advancing age, and this misalignment may serve as an indicator of future fall-related fractures. Vertebral fractures, which commonly occur in patients with osteoporosis, have distinct characteristics compared with other fall-related fractures and should therefore be separately evaluated. This study aimed to investigate the association between future fall-related fractures and sagittal spinal alignment, excluding vertebral fractures.
A total of 333 women with osteoporosis were recruited and followed up between November 2013 and July 2024. At baseline, information on medication status and bone mineral density in the lumbar spine and femoral neck was obtained from the patients' medical record. Furthermore, the locomotive syndrome (LOCOMO) stage was assessed via risk tests, and sagittal alignment parameters, including sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic incidence (PI), and lumbar lordosis (LL), were evaluated. In addition, Cox proportional hazards regression analysis was conducted to determine the risk of fall-related fractures based on all variables.
The mean follow-up period was 5.4 years. The final sample for assessing fall-related fracture incidence consisted of 214 participants. Fall-related fractures occurred in 31 of the 333 participants (9.3%). Cox proportional hazards regression analysis, adjusted for all variables, revealed that SVA (hazard ratio [HR]=1.011, 95% confidence interval [CI] 1.003-1.02), LL (HR=1.039, 95% CI 1.007-1.072), LOCOMO stage (HR=1.801, 95% CI 1.127-2.879), and presence of parathyroid hormone (HR=0.165, 95% CI 0.031-0.891) are independent risk factors for future fall-related fractures.
Awareness of fall-related fracture risks can be increased by monitoring the SVA, LL, and LOCOMO stage as well as administering parathyroid hormone medications. While the deterioration of sagittal spinal alignment is a well-known factor in vertebral fractures, this study suggests that future fall-related fractures, excluding vertebral fractures, are influenced by sagittal spinal alignment.
骨质疏松女性的脊柱排列往往会随着年龄的增长而恶化，这种排列不齐可能是未来与跌倒相关骨折的一个指标。椎体骨折常见于骨质疏松患者，与其他与跌倒相关的骨折相比具有明显特征，因此应单独评估。本研究旨在调查排除椎体骨折后未来与跌倒相关骨折与矢状面脊柱排列之间的关联。
2013年11月至2024年7月期间，共招募了333名骨质疏松女性并进行随访。在基线时，从患者病历中获取用药情况以及腰椎和股骨颈骨密度的信息。此外，通过风险测试评估运动综合征（LOCOMO）阶段，并评估矢状面排列参数，包括矢状垂直轴（SVA）、胸椎后凸（TK）、骨盆入射角（PI）和腰椎前凸（LL）。另外，进行Cox比例风险回归分析以确定基于所有变量的与跌倒相关骨折的风险。
平均随访期为5.4年。评估与跌倒相关骨折发生率的最终样本包括214名参与者。333名参与者中有31人（9.3%）发生了与跌倒相关的骨折。对所有变量进行调整后的Cox比例风险回归分析显示，SVA（风险比[HR]=1.011，95%置信区间[CI] 1.003 - 1.02）、LL（HR=1.039，95% CI 1.007 - 1.072）、LOCOMO阶段（HR=1.801，95% CI 1.127 - 2.879）以及甲状旁腺激素的存在（HR=0.165，95% CI 0.031 - 0.891）是未来与跌倒相关骨折的独立危险因素。
通过监测SVA、LL和LOCOMO阶段以及使用甲状旁腺激素药物，可以提高对与跌倒相关骨折风险的认识。虽然矢状面脊柱排列恶化是椎体骨折的一个众所周知的因素，但本研究表明，排除椎体骨折后，未来与跌倒相关的骨折受矢状面脊柱排列的影响。
