Li Jun, Strahl André, Kunze Beate, Krebs Stefan, Stangenberg Martin, Viezens Lennart, Strube Patrick, Dreimann Marc
Spine Center for Neuroorthopaedics, Spinal Cord Injuries, and Scoliosis, RKH Orthopaedic Clinic Markgröningen, 71706 Markgröningen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
J Clin Med. 2025 Jul 27;14(15):5296. doi: 10.3390/jcm14155296.
: Pathological vertebral fragility (path-VF) increases the risk of osteoporotic fractures and pedicle screw loosening (PSL) after posterior instrumented spinal fusion (PISF). While WHO body mass index (BMI) categories broadly identify risks related to underweight and obesity, fixed thresholds may inadequately reflect vertebral fragility risks among elderly patients, especially within the normal-weight range. This study investigates whether current BMI classifications sufficiently capture the risk of path-VF in older adults. : This retrospective study included 225 patients who underwent kyphoplasty or PISF (2022-2023). Path-VF was defined by non-tumorous fractures, screw reinforcement, or PSL within six months without prior reinforcement. Patients were grouped into the path-VF (n = 94) and control (n = 131) groups. HU and BMI values, BMI-related ORs, and age trends were analysed, and a logistic regression was performed. : Mean HU values were significantly lower in the path-VF group (71.37 ± 30.50) than in controls (130.35 ± 52.53, < 0.001). Path-VF females (26.26 ± 5.38) had a lower BMI than the control females (29.33 ± 5.98, = 0.002); no difference was found in males. Normal-weight females showed a borderline risk for path-VF (OR 2.03, = 0.0495). Obesity (OR 0.31/OR 0.37) and being male and overweight (OR 0.21) were protective (all < 0.05). BMI declined with age in path-VF males ( = 0.001) but increased in the controls ( = 0.023). A logistic regression identified a BMI < 22.5 kg/m and age > 67.5 years as significant risk thresholds. Notably, 20.2% of path-VF patients over 67.5 had a normal weight, suggesting a potentially overlooked subgroup. : The current WHO lower limit for normal BMI (18.5 kg/m) may underestimate the risk of path-VF in patients older than 67.5 years, potentially overlooking 24.7% of cases. The results offer a new approach for clinicians to interpret BMI values at the lower end of the normal range (<22.5 kg/m) with caution in elderly patients undergoing spinal surgery.
病理性椎体脆性（path-VF）会增加骨质疏松性骨折的风险以及后路器械辅助脊柱融合术（PISF）后椎弓根螺钉松动（PSL）的风险。虽然世界卫生组织（WHO）的体重指数（BMI）类别大致可识别与体重过轻和肥胖相关的风险，但固定阈值可能无法充分反映老年患者的椎体脆性风险，尤其是在正常体重范围内。本研究调查了当前的BMI分类是否足以捕捉老年人中path-VF的风险。
这项回顾性研究纳入了225例行椎体成形术或PISF的患者（2022年至2023年）。Path-VF的定义为非肿瘤性骨折、螺钉加固或在未预先加固的情况下六个月内发生的PSL。患者被分为path-VF组（n = 94）和对照组（n = 131）。分析了HU和BMI值、与BMI相关的比值比（OR）以及年龄趋势，并进行了逻辑回归分析。
Path-VF组的平均HU值（71.37±30.50）显著低于对照组（130.35±52.53，P<0.001）。Path-VF组的女性（26.26±5.38）BMI低于对照组女性（29.33±5.98，P = 0.002）；男性中未发现差异。正常体重的女性显示出path-VF的临界风险（OR 2.03，P = 0.0495）。肥胖（OR 0.31/OR 0.37）以及男性且超重（OR 0.21）具有保护作用（均P<0.05）。Path-VF组男性的BMI随年龄下降（P = 0.001），而对照组则上升（P = 0.023）。逻辑回归确定BMI<22.5 kg/m和年龄>67.5岁为显著的风险阈值。值得注意的是，67.5岁以上的path-VF患者中有20.2%体重正常，这表明可能存在一个被忽视的亚组。
世界卫生组织当前正常BMI的下限（18.5 kg/m）可能低估了67.5岁以上患者path-VF的风险，可能会遗漏24.7%的病例。研究结果为临床医生在对接受脊柱手术的老年患者解读正常范围下限（<22.5 kg/m）的BMI值时提供了一种新的谨慎方法。
