Koto Ruriko, Yoshida Shiori, Nakajima Akihiro, Miwa Tetsuya, Miyakoshi Naohisa
Medical Science Department, Teijin Pharma Limited, 2-1, Kasumigaseki 3-chome Chiyoda-ku, Tokyo, 100-8585, Japan.
Clinical Development Control Department, Teijin Pharma Limited, Tokyo, Japan.
J Bone Miner Metab. 2025 Sep 17. doi: 10.1007/s00774-025-01639-2.
This study aimed to investigate perioperative treatment and postoperative outcomes in osteoporotic patients with vertebral fractures (VFs), categorized by the type of spine surgery.
Patients aged ≥ 40, diagnosed with VFs and osteoporosis, with initial spine surgery between April 2015 and February 2021, were analyzed using a Japanese claims database. Time-to-event analysis was conducted for postoperative outcome. Outcome-related factors were explored with a multivariable Cox proportional hazards model.
The study population (n = 4870) consisted of 2675 patients in the percutaneous vertebroplasty (PVP) group and 2195 in the spine fusion surgery (SFS) group. Most patients had lumbar VFs, and posterior spinal fusion was common in the SFS group. Approximately 20% of patients did not receive prescriptions for osteoporosis medications during the perioperative period. Most reoperations and subsequent fractures occurred within 90 days after PVP or SFS. In the PVP group, degenerative spine disease (adjusted hazard ratio 1.34 [95% CI, 1.03-1.76]), psychotropic drugs (1.34 [1.03-1.76]), and glucocorticoid prescriptions with a mean dose of ≥ 5 to < 7.5 mg/day (2.35 [1.04-5.34]) (vs. < 1 mg/day) were associated with reoperation. In post hoc subgroup analysis by year of spine surgery, anabolic agents were associated with a lower risk of reoperation (0.48 [0.30-0.75]) in 2019 and later. In the SFS group, hyperparathyroidism and Parkinson's disease were associated with reoperation (2.14 [1.03-4.44] and 2.10 [1.31-3.37], respectively).
Perioperative osteoporosis medication may be suboptimal. Factors associated with postoperative outcomes must be considered, with the strategic goal of improving patient outcomes.
本研究旨在根据脊柱手术类型，调查骨质疏松性椎体骨折（VF）患者的围手术期治疗及术后结局。
使用日本索赔数据库对年龄≥40岁、诊断为VF和骨质疏松症、在2015年4月至2021年2月期间首次接受脊柱手术的患者进行分析。对术后结局进行事件发生时间分析。采用多变量Cox比例风险模型探索与结局相关的因素。
研究人群（n = 4870）包括经皮椎体成形术（PVP）组的2675例患者和脊柱融合手术（SFS）组的2195例患者。大多数患者为腰椎VF，后路脊柱融合术在SFS组中很常见。约20%的患者在围手术期未接受骨质疏松症药物处方。大多数再次手术和随后的骨折发生在PVP或SFS后90天内。在PVP组中，退变性脊柱疾病（调整后风险比1.34 [95% CI，1.03 - 1.76]）、精神药物（1.34 [1.03 - 1.76]）以及平均剂量≥5至＜7.5 mg/天的糖皮质激素处方（2.35 [1.04 - 5.34]）（vs. ＜1 mg/天）与再次手术相关。在按脊柱手术年份进行的事后亚组分析中，2019年及以后，合成代谢药物与再次手术风险较低相关（0.48 [0.30 - 0.75]）。在SFS组中，甲状旁腺功能亢进和帕金森病与再次手术相关（分别为2.14 [1.03 - 4.44]和2.10 [1.31 - 3.37]）。
围手术期骨质疏松症药物治疗可能并不理想。必须考虑与术后结局相关的因素，以改善患者结局为战略目标。
