Hiroyuki Inose1, Tsuyoshi Kato2,3, Shoichi Ichimura4, Hiroaki Nakamura5, Masatoshi Hoshino5, Daisuke Togawa6, Toru Hirano7, Yasuaki Tokuhashi8, Tetsuro Ohba9, Hirotaka Haro9, Takashi Tsuji10, Kimiaki Sato11, Yutaka Sasao12, Masahiko Takahata13, Koji Otani14, Suketaka Momoshima15, Kunihiko Takahashi16, Masato Yuasa3, Takashi Hirai3, Toshitaka Yoshii3, Atsushi Okawa3. 1. Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan. inose.orth@tmd.ac.jp. 2. Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan. 3. Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan. 4. Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan. 5. Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan. 6. Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan. 7. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan. 8. Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan. 9. Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan. 10. Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan. 11. Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan. 12. Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan. 13. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan. 14. Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan. 15. Department of Diagnostic Radiology, Center for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan. 16. Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan.
Abstract
PURPOSE: To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures. METHODS: This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed. RESULTS: Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65-85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment. CONCLUSION: Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures. LEVEL OF EVIDENCE: III.
PURPOSE: To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures. METHODS: This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed. RESULTS: Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65-85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment. CONCLUSION: Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures. LEVEL OF EVIDENCE: III.
Authors: Ory Keynan; Charles G Fisher; Alexander Vaccaro; Michael G Fehlings; F C Oner; John Dietz; Brian Kwon; Raj Rampersaud; Christopher Bono; John France; Marcel Dvorak Journal: Spine (Phila Pa 1976) Date: 2006-03-01 Impact factor: 3.468
Authors: R Lindsay; S L Silverman; C Cooper; D A Hanley; I Barton; S B Broy; A Licata; L Benhamou; P Geusens; K Flowers; H Stracke; E Seeman Journal: JAMA Date: 2001-01-17 Impact factor: 56.272