Prevalent osteoporotic vertebral fractures more likely involve the upper endplate than the lower endplate and even more so in males

Abstract

Background: While the importance of identifying osteoporotic vertebral endplate fracture (EPF) is being recognized; the pathophysiological understanding of EPF till now remain insufficient. In this populationbased cross-sectional radiograph study, we aim to investigate the anatomic location characteristics of osteoporotic EPF. Methods: This study analyzed the anatomical location of osteoporotic EPFs in elderly Chinese population (age ≥65 years). The T4-L4 radiographs of 1,954 elderly Chinese men (mean: 72.3 years) and 1,953 elderly Chinese women (mean: 72.5 years) were evaluated to identify EPF, and vertebral bodies were graded according to Genant's vertebral deformity criteria. Results: Of the 101,582 endplates analyzed, there were 505 EPFs (males: 27.7%; females: 72.3%). Excluding those with both upper endplate and lower endplate involvements, the ratio of upper EPF to lower EPF was 9.63 for males and 4.3 for females (P<0.05). Thoracolumbar junction, particularly L1 (26.4% for males and 24.1% for females) and followed by T12 (20.7% for males and 19.7% for females), had highest prevalence of EPF. With an endplate divided into 5 segments of equal length in the anteroposterior direction and grade 0.5 & 1, grade 2 vertebral deformities analyzed, fractures occurred mostly at the middle segment (70.1% for upper endplates in males and 78.6% for upper endplates in females), followed by second anterior segment (20.9% for upper endplates in males and 14.4% for upper endplates in females). The most anterior and most posterior segments were not primarily involved in EPF. Conclusions: Osteoporotic EPFs more likely involve the upper endplate rather than lower endplate, with a trend for this effect to be greater in men than in women. These characteristics may help radiographic differential diagnosis for osteoporotic EPF.

Radiological features of traumatic vertebral endplate fracture: an analysis of 194 cases with 263 vertebral fractures

“…We showed that except traumatic EPF involved both sEP and iEP, only approximately 1.9% involved iEP alone. This results contrast with osteoporotic EPF results, [ 19 ] where for singular EPF (only one EP in a vertebra), the ratio of superior EPF occurrence to inferior EPF occurrence was 9.63 (9.8% involved iEP) for males and 4.3 (17.4% involved iEP) for females. Thus iEP is more weakened during osteoporosis such that inferior EPF is relatively more common in osteoporotic VF than traumatic VF.…”

“…Traumatic EPF features are then compared with the features of osteoporotic EPF as recently detailed by us. [ 13 , 14 , 16 , 18 , 19 ]…”

How to define an osteoporotic vertebral fracture?

“…Genant et al assumed that endplate fracture is 100% sensitive for osteoporotic fracture (46), but ABQ approach not include anterior cortex buckling which is quite common as VF sign (Figure 3) (51). Furthermore, endplate fracture does not always occur at the center of endplate (52). Finally, the ABQ do not take account for grading the extent of vertebral height loss.…”

Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures

“…Compared with those of conservative treatment, the outcomes of PV have been reported to benefit patients, thus providing better pain relief. However, the beneficial effects of PV have been reported to be associated with a higher incidence of new ASFs compared to conservative treatment [1][2][3][4][5][6][7][8] . Studies have reported that PV is not Table 3.…”

“…OTFs can also be managed by percutaneous vertebroplasty (PV) or percutaneous kyphoplasty (PK). Both treatments are not perfect, and although various studies have described the outcomes and complications of each treatment, there is still no consensus on the optimal treatment regimen for OTFs 7,8 . Our study was a retrospective analysis that reported a series of OTF patients treated with PV, and it investigated the risk factors for adjacent segmental fractures (ASFs) based on the assessment of fractured vertebral kyphosis alignment on plain radiography and magnetic resonance imaging (MRI).…”