Risk Factors for New Osteoporotic Vertebral Compression Fractures After Vertebroplasty

Zhang, Zitao; Fan, Jin; Ding, Qingfeng; Wu, Min; Yin, Guoyong

doi:10.1097/bsd.0b013e31827412a5

Cited by 62 publications

(53 citation statements)

References 34 publications

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“…33 Recent studies have also shown that cement leakage into the disc space has a higher risk of resulting in adjacent level fractures. 34,35 Although our study did not have this complication, we agree that in light of the available evidence, this should be carefully avoided. This is a study on patients with osteoporotic compression fractures who underwent cement augmentation of the spine.…”

Section: Discussionsupporting

confidence: 54%

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Hey

Tan

et al. 2015

SPINE

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Study Design. A case-control study.Objective. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Summary of Background Data. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. Methods. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. Results. 93 patients followed up for a mean duration of 25.1 months (12 -96) had a mean age of 76.8 years (47 -99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of À2.860 (95% confidence interval À3.268 to À2.452) and nonfractured vertebra had a mean T-score of À2.180 (95% confidence interval À2.373 to À1.986). A T-score of À2.2 or lower is predictive of refracture at that vertebra (P ¼ 0.047). Odds ratio increases with decreasing T-scores from À2.2 or lower to À2.6 or lower. A T-score of À2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P ¼ 0.049) and loss of preoperative anterior vertebral height (P ¼ 0.017) are associated with refracture. Conclusion. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower Tscores from À2.2 or less to À2.6 or less. They have a low positive predictive value, but a high negative predictive value for subsequent fractures. Other significant associations with subsequent refractures include age and anterior vertebral height.

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Section: Discussionsupporting

confidence: 54%

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Hey

Tan

et al. 2015

SPINE

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“…A low BMI was found to be a risk factor for fracture recurrence in the spine or hip [32] and for new VCFs after vertebroplasty [33,34]. Interestingly, being overweight or obese was found to increase the incidence of vertebral fracture [35].…”

Section: Discussionmentioning

confidence: 95%

Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty

et al. 2015

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“…This may be due to increased transmission of axial weightbearing force on the adjacent vertebral endplates by the hard cement in the treated vertebrae (167,168). High injection volume (169), cement leakage at the site of vertebral augmentation (170,171), age O80 yr (172), treatment of O1 vertebral level (172), and low serum vitamin D levels (172) may further increase the risk of subsequent adjacent vertebral fracture.…”

Section: Individual Clinical Characteristics Associated With Incidentmentioning

confidence: 97%

Epidemiology of Vertebral Fractures

Schousboe

2016

Journal of Clinical Densitometry

324

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Risk Factors for New Osteoporotic Vertebral Compression Fractures After Vertebroplasty

Abstract: The results of this meta-analysis strongly suggested that patients with low BMD, low BMI, and intradiscal cement leakage were at high risk for new VCFs after vertebroplasty, and risk-reduction options should be considered for such patients.

Cited by 62 publications

References 34 publications

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty

Epidemiology of Vertebral Fractures

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