P43. Percutaneous vertebroplasty for vertebral compression fracture in glucocorticosteroid-induced osteoporosis: a case-control study

Abstract

BACKGROUND CONTEXT Glucocorticoids-induced osteoporosis (GIOP) is a common form of secondary osteoporosis that often precipitates osteoporotic vertebral compression fracture (VCF). Comparing to conservative therapeutic strategies for VCF, percutaneous vertebroplasty (PVP) could quickly relieve back pain and improve overall life quality. But recent studies demonstrate that the risk of refracture following PVP surgery is high among patients with GIOPVCF. Thus, it is vital that the outcomes of different treatments for GIOPVCF are clearly understood and the clinical guidelines for treating this disease are defined. We designed a prospective cohort study to compare differences of therapeutic effects and incidence of refractures between conservative treatment and PVP for GIOPVCF. PURPOSE To investigate the clinical characteristics of vertebral compression fracture (VCF) in glucocorticosteroid-induced osteoporosis (GIOP) and risk of vertebral refracture after percutaneous vertebroplasty (PVP) STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 570 cases who received PVP as treatments of VCF from January 2010 to December 2013 were retrospective reviewed. Forty-two cases were GIOP and 21 cases were followed up as GIOP group, other 528 cases were primary osteoporosis and 391 cases were followed up, 84 cases of them were selected based on age and gender as control group. OUTCOME MEASURES Primary Outcome Measure: Incidence of vertebral refracture; Secondary Outcome Measure: fracture location, ratio of single segment fracture and multiple segments fracture in two groups. METHODS Compared the fracture location, ratio of single segment fracture and multiple segments fracture in two groups. In final follow up, compared the reoperation rate for vertebral refractures by the Kaplan-Meier methodin two groups. RESULTS Follow-up period were 24.0±13.1 months in GIOP group and 25.8±14.4 months in control group (P>0.05). In GIOP group, there were 11 cases with one-segment fracture, 2 cases with two-segments fracture, 3 cases with three-segments fracture, 2 cases with four-segments fracture, 2 cases with five-segments fracture and 1 case with eight-segments fracture. In control group, there were 67 cases with one-segment fracture, 12 cases with two-segments fracture, 3 cases with three-segment fracture, 2 cases with four-segments fracture. The ratio of single segment fracture in GIOP group was significantly lower than that in control group (52.4% vs 79.8%, P=0.01. There were 50 fracture segments in GIOP group and 109 fracture segments in control group. The ratio of fracture segments located in thoracic segments (T1-T10, thoracolumbar segments (T11-L1) and lumbar segments (L2-L5) was 18%, 46% and 36% in GIOP group and 11.9%,58.7% and 29.4% in control group (P>0.05). The refracture rate in GIOP group was higher than that in control group (23.8% vs 6.0%. The survival rate is lower in GIOP group than that in control group (P CONCLUSIONS Predilection site of VCF was similar in GIOP and primary osteoporosis (thoracolumbar segments> thoracic segments > lumbar segments). The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP was higher in GIOP than in primary osteoporosis. FDA DEVICE/DRUG STATUS Stryker PCD Mixer and Delivery System (Approved for this indication).