Soto-Subiabre Mauricio, Mayoral Victor, Valencia-Muntalà Lidia, González Carlos, Gómez-Vaquero Carmen
School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain.
J Bone Metab. 2025 May;32(2):143-154. doi: 10.11005/jbm.25.835. Epub 2025 May 31.
To investigate the contribution of radiological characteristics of baseline fragility vertebral fractures (FVF) and clinical characteristics to the development of radiological worsening (RW).
Patients were recruited between 2015 and 2018. The primary outcome was the identification of RW in a radiological second image, defined as the progression of prevalent FVF, new FVF, or both. Data on fracture risk fractures, bone mineral density, analgesia requirements, and antiosteoporosis treatment were recorded. The radiological features of baseline FVF included fracture number, location(s), severity grade (Genant method), kyphosis angle, and spine index deformity.
A total of 223 patients with at least one follow-up radiological evaluation were included. Another 199 patients had no radiological follow-up. Of those with follow-up, 69% presented RW, accounting for 36.5% of the total cohort (422 patients). The incidence rate of RW was 73.8/1,000 patient-years. Among those with RW, 61% showed progression of FVF, 27% developed new FVF, and 12% had both. The multivariate analysis demonstrated that multiple FVF and worse grades of FVF at baseline were variables significantly associated with RW. Baseline characteristics of FVF that increased the risk of RW by progression of FVF was grade 1 (odds ratio [OR], 3.22; 95% confidence interval [CI], 1.47-7.02) and grade 2 (OR, 1.97; 95% CI, 1.05-3.68) and by new FVF was grade 3 (OR, 3.19; 95% CI, 1.39-7.33) FVF.
Approximately one-third of patients with FVF experienced RW, with progression of FVF being the most common event. A higher number of FVF and a greater severity at baseline are associated with RW.
探讨基线脆性椎体骨折（FVF）的放射学特征和临床特征对放射学恶化（RW）发展的影响。
在2015年至2018年期间招募患者。主要结局是在第二次放射学影像中识别RW，定义为现患FVF进展、新发FVF或两者皆有。记录骨折风险骨折、骨密度、镇痛需求和抗骨质疏松治疗的数据。基线FVF的放射学特征包括骨折数量、部位、严重程度分级（Genant法）、后凸角和脊柱指数畸形。
共纳入223例至少接受过一次放射学随访评估的患者。另外199例患者未进行放射学随访。在有随访的患者中，69%出现RW，占整个队列（422例患者）的36.5%。RW的发生率为73.8/1000患者年。在出现RW的患者中，61%表现为FVF进展，27%出现新发FVF，12%两者皆有。多变量分析表明，基线时多个FVF以及FVF更严重的分级是与RW显著相关的变量。因FVF进展增加RW风险的FVF基线特征为1级（比值比[OR]，3.22；95%置信区间[CI]，1.47 - 7.02）和2级（OR，1.97；95% CI，1.05 - 3.68），因新发FVF增加RW风险的是3级FVF（OR，3.19；95% CI，1.39 - 7.33）。
约三分之一的FVF患者经历了RW，FVF进展是最常见的情况。基线时FVF数量较多和严重程度较高与RW相关。
