History Of Vertebral Fracture Research Articles

Incidence and prognostic factors of residual back pain in patients treated for osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

Osteoporotic vertebral compression fracture (OVCF) is a common consequence of osteoporosis and can significantly impact the quality of life for affected individuals. Despite treatment options such as vertebroplasty and kyphoplasty, many patients continue to experience residual back pain (RBP) even after the fracture has healed. The incidence of RBP after OVCF treatment varies among studies, and there is a need for further research to understand the risk factors associated with RBP. A systematic review and meta-analysis were conducted following the PRISMA guidelines. Electronic databases were searched, and relevant studies were selected based on inclusion and exclusion criteria. Data extraction and quality assessment were performed independently by two authors. Statistical analysis included single-proportion meta-analyses and pooling of odds ratios (OR) using the inverse-variance method, to calculate the overall incidences of RBP and cement leakage and identify risk factors associated with RBP. A total of 19 studies were included in the analysis. The overall incidences of RBP and cement leakage were found to be 16% and 18%, respectively. Several risk factors were identified, including gender, bone mineral density, depression, baseline visual analog scale (VAS) score, intravertebral vacuum cleft, number of fractured segments, cement distribution, history of vertebral fracture, thoracolumbar fascial injury, and fracture non-union. This study provides potential value within the scope of the incidence and risk factors of RBP following treatment of OVCFs. The identified risk factors can help clinicians identify high-risk patients and tailor appropriate interventions. Future research should focus on standardizing the definition of RBP and patient selection criteria to improve the accuracy of estimates and facilitate better management strategies for OVCF patients.

Development and Validation of Machine Learning-Based Predictive Model for Prolonged Hospital Stay after Decompression Surgery for Lumbar Spinal Canal Stenosis.

Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction models lack accuracy and generalizability. Machine learning can improve accuracy by considering preoperative factors. This study aimed to develop and validate a machine learning-based model for estimating hospital stay duration following decompression surgery for LSS. Data from 848 patients who underwent decompression surgery for LSS at three hospitals were examined. Twelve prediction models, using 79 preoperative variables, were developed for postoperative hospital stay estimation. The top five models were chosen. Fourteen models predicted prolonged hospital stay (≥14 days), and the most accurate model was chosen. Models were validated using a randomly divided training sample (70%) and testing cohort (30%). The top five models showed moderate linear correlations (0.576-0.624) between predicted and measured values in the testing sample. The ensemble of these models had moderate prediction accuracy for final length of stay (linear correlation 0.626, absolute mean error 2.26 days, standard deviation 3.45 days). The c5.0 decision tree model was the top predictor for prolonged hospital stay, with accuracies of 89.63% (training) and 87.2% (testing). Key predictors for longer stay included JOABPEQ social life domain, facility, history of vertebral fracture, diagnosis, and Visual Analogue Scale (VAS) of low back pain. A machine learning-based model was developed to predict postoperative hospital stay after LSS decompression surgery, using data from multiple hospital settings. Numerical prediction of length of stay was not very accurate, although favorable prediction of prolonged stay was accomplished using preoperative factors. The JOABPEQ social life domain score was the most important predictor.

Abstract #1403692: Discrepancy Between Dual-Energy X-ray Absorptiometry and Quantitative Computed Tomography in Analyzing Bone Mineral Density in a Patient with Primary Hyperparathyroidism, Fractures and Degenerative Joint Disease - A Case Report and Review of Literature

Primary hyperparathyroidism is associated with lower bone mineral density (BMD). Dual-energy x-ray absorptiometry (DXA) is the gold standard to measure BMD and a T-score of less than -2.5 is an indication for parathyroidectomy. However, DXA has limitations in skeletal evaluation of patients with primary hyperparathyroidism and degenerative joint disease (DJD). The use of quantitative computed tomography (QCT) should be considered for these patients to accurately assess their BMD to guide proper management. 87-year-old female with a past medical history of primary hyperparathyroidism and DJD. She has a previous history of two left femoral fractures and underwent surgical repair. She was not considered for parathyroidectomy based on her age, serum calcium, and absence of renal and skeletal indications for surgery given that her BMD only reveals osteopenia. Patient experienced sudden-onset low back pain and MRI of the spine revealed L1 compression fracture and diffuse DJD. QCT showed severe osteoporosis with BMD of 21.8 mg/c (T-score equivalent of -5.64) while her DXA only showed osteopenia on the lumbar spine and right femoral neck with T-score of -1.4 and -2.3, respectively. Based on the history of vertebral fracture and QCT result, patient was referred for parathyroidectomy. Osteoporosis is a degenerative disease of the bone characterized by low BMD which predisposes patients to low-impact, fragility fractures. Regular assessment of BMD in patients with primary hyperparathyroidism is beneficial to evaluate the need for parathyroidectomy. While current guidelines suggest the use of DXA to assess BMD, it does not always reflect the accurate state of the bones. From the review of the literature, the difference of T-scores between DXA and QCT is due to an artifact from arthritic changes and degenerative disease. DXA evaluates cortical bone and findings can be influenced by degenerative changes and facet joint hypertrophy, which is strongly associated with the overestimation of the BMD. QCT, on the other hand, evaluates trabecular and cortical bone separately and is not affected by arthrosic changes and vascular calcifications. Clinicians should be aware of the discrepancy and should consider QCT instead of DXA for screening and diagnosing of osteoporosis in patients with primary hyperparathyroidism, DJD and history of fractures. If the skeletal assessment was done by QCT and not DXA, parathyroidectomy could have been done earlier preventing her vertebral fracture. Therefore, we suggest adding the option to perform QCT instead of DXA for the skeletal assessment of patients with asymptomatic hyperparathyroidism who has DJD.

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Determinants of Observance to Osteoporosis Treatment in Clinical Practice in a Single Center Study

Background: Improve compliance to prescribed medications is common in clinical practice, and it can lead to potentially fatal outcomes. This continues to be a common issue in the treatment of osteoporosis, although the causes of discontinuation and low compliance are complicated and understudied.Material & Methods:A survey was conducted in 101 patients at Narsingdi Sadar Hospital, Narsingdi, Dhaka, Bangladesh for osteoporosis management for a follow-up assessment, one year (July 2020 to June 2021) after having been prescribed a treatment with one of the following drugs: Calcium+vitamin D supplements alone (CaVitD), hormone replacement therapy (HRT), risedronate 5 mg/day (RIS), alendronate (ALN OW), Ibandronic acid monthly and Zolindronic acid I/V inj yearly.Results:Overall, 19.1 % stopped taking their prescribed medication before their bone mass reevaluations, with more than half of them doing so within the first 6 months. The dropout rate differed dramatically between regimens. ALN-OW was by far the least interrupted (6.9 %; p0.001 versus any other treatment). The most common causes for cessation were drug-related side effects, a lack of willingness to continue therapy, and a fear of negative effects. The reasons for discontinuation differed by treatment: safety concerns were very common for HRT, lack of motivation was the most common cause for CaVitD and drug-related side effects were the most common cause for RIS, ALN, Ibandronic acid and Zolindronic acid . Patients having a history of vertebral fractures, densito-metric osteoporosis, or who were using corticosteroid or anti-inflammatory medications had a considerably greater rate of treatment adherence. Patients on benzodiazepine or gastroprotective drugs, as well as those for whom a bone measurement was not easily accessible, had a considerably greater probability of treatment interruption. ALN OW and HRT had the highest compliance to recommended dosing (p0.001 versus any other) and CaVitD had the lowest (p0.01 versus any other). Poor treatment compliance (50 percent medicine taken) was strongly associated with benzodiazepine and gastroprotective usage, whereas significantly higher compliance was associated with established osteoporosis risk factors: early menopause, low bone mass values, and past vertebral fractures. Adherence was lowest when treatments were prescribed by general practitioners (GPs) and orthopaedic surgeons (p0.01 compared to the global mean).Conclusions:According to the conclusions of this large survey of Bangladeshi osteoporotic women, the kind of medicine provided is the most important factor of both persistence

Serum Periostin Level and Genetic Polymorphisms Are Associated with Vertebral Fracture in Chinese Postmenopausal Women

Purposes: In order to investigate the association between serum periostin levels and the variation of its encoding gene POSTN and the prevalence of vertebral fractures and bone mineral density (BMD) in Chinese postmenopausal women, an association study was performed. Materials and Methods: 385 postmenopausal women were recruited. For participants without a history of vertebral fracture, lateral X-rays of the spine covering the fourth thoracic spine to the fifth lumbar spine were performed to detect any asymptomatic vertebral fractures. Ten tag-single nucleotide polymorphisms (SNP) of POSTN were genotyped. Serum periostin levels, biochemical parameters, and BMD were measured individually. Results: rs9603226 was significantly associated with vertebral fractures. Compared to allele G, the minor allele A carriers of rs9603226 had a 1.722-fold higher prevalence of vertebral fracture (p = 0.037). rs3923854 was significantly associated with the serum periostin level. G/G genotype of rs3923854 had a higher serum periostin level than C/C and C/G (67.26 ± 19.90 ng/mL vs. 54.57 ± 21.44 ng/mL and 54.34 ± 18.23 ng/mL). Furthermore, there was a negative correlation between the serum level of periostin and BMD at trochanter and total hip. Conclusion: Our study suggested that genetic variation of POSTN could be a predicting factor for the risk of vertebral fractures. The serum level of periostin could be a potential biochemical parameter for osteoporosis in Chinese postmenopausal women.

The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis

PurposeOsteoporosis combined with sarcopenia contributes to a high risk of falling, fracture, and even mortality. However, sarcopenia’s impact on low back pain and quality of life (QOL) in patients with osteoporosis is still unknown. The purpose of this study is to investigate low back pain and QOL in osteoporosis patients with sarcopenia.MethodsWe assessed 100 ambulatory patients who came to our hospital for osteoporosis treatment. Low back pain was evaluated using the Visual Analogue Scale (VAS) with 100 being an extreme amount of pain and 0 no pain. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score was used to assess QOL after adjustment for age, history of vertebral fracture, and adult spinal deformity. Differences in low back pain intensity assessed by VAS between groups were evaluated by the Willcoxon rank-sum test. Covariance analysis was used to assess QOL. All data are expressed as either median, interquartile range, or average, standard error.ResultsPatients were classified into the sarcopenia group (n = 32) and the non-sarcopenia group (n = 68). Low back pain intensity assessed by VAS was significantly higher in the sarcopenia group than in the non-sarcopenia group (33.0 [0-46.6] vs. 8.5 [0-40.0]; p < 0.05). The subscales of the JOABPEQ for low back pain were significantly lower in the sarcopenia group than in the non-sarcopenia group (65.0 ± 4.63 vs. 84.0 ± 3.1; p < 0.05).ConclusionIn this cross-sectional study, sarcopenia affected low back pain and QOL in ambulatory patients with osteoporosis. Sarcopenia may exacerbate low back pain and QOL.

Glucocorticoids Are Not Associated with Bone Mineral Density in Patients with Polymyalgia Rheumatica, Giant Cell Arteritis and Other Vasculitides-Cross-Sectional Baseline Analysis of the Prospective Rh-GIOP Cohort.

Background: Glucocorticoids (GCs) can cause osteoporosis (OP). Prior observational research on bone density and the effects of GCs in polymyalgia rheumatica (PMR) and vasculitides is scarce and inconclusive. Methods: Rh-GIOP is a prospective cohort study of bone health in patients with inflammatory rheumatic diseases. In this cross-sectional baseline analysis, we focused on patients with PMR and different forms of vasculitides. Multivariable linear regression was used to model the effect of current and cumulative GC intake on the minimum T-score at any site (mTs; at either lumbar spine or hip), with comprehensive adjustment for confounders. In separate models, GCs were modelled both as continuous and categorical predictors. Sensitivity analyses, stratifying by measurement site and disease, were conducted. Results: A total of 198 patients, with a mean age of 67.7 ± 11.4 years and a mean disease duration of 5.3 ± 6.3 years, were included. Most patients suffered from PMR (36%), giant cell arteritis (26%) or granulomatosis with polyangiitis (17%). Women comprised 66.7% of the patients, and 87.4% were currently taking GCs. The mean CRP was 13.2 ± 26.1 mg/L. OP diagnosed by dual energy X-ray absorptiometry (DXA) (T-score ≤ −2.5) was present in 19.7% of the patients. While 88% were taking vitamin D supplements, calcium supplementation (4%) and treatment with anti-resorptive agents (17%) were relatively infrequent. Only 7% had a vitamin D deficit. Neither current (β(continuous model) = −0.01, 97.5% CI –0.02 to 0.01; p(all models) ≥ 0.49) nor cumulative (β(continuous model) = 0.01, 97.5% CI −0.04 to 0.07; p(all models) ≥ 0.35) GC doses were associated with mTs in any model. CRP was not associated with mTs in any model (p(all models) ≥ 0.56), and no interaction between CRP and GC intake was observed (p for interaction(all models) ≥ 0.32). Across all analyses, lower body mass index (p(all models) ≤ 0.01), history of vertebral fractures (p(all models) ≤ 0.02) and proton-pump inhibitor intake (p(all models) ≤ 0.04) were associated with bone loss. Sensitivity analyses with femoral neck and lumbar spine T-scores as dependent variables led to similar results as the analysis that excluded patients with PMR. Conclusions: In this cohort of PMR and vasculitides, we found a similar prevalence of OP by DXA to the overall elderly German population. Vitamin D supplementation was very common, and vitamin D insufficiency was less frequent than expected in Germans. There was no association between current or cumulative GC intake, CRP and impaired bone density. Proton-pump inhibitors seem to be a major, but somewhat neglected, risk factor for OP and should be given more attention. Our findings require confirmation from longitudinal analyses of the Rh-GIOP and other cohorts.

Bone mineral density and risk factors of osteoporosis in children

Background: Osteoporosis (OP) is a worldwide problem that could affect children. Aim of the work: to evaluate bone mineral density (BMD) and assess risk factors of OP in children. Patients and methods: This study was carried out on 960 children (410 male and 550 female). All children were subjected to full medical, nutritional history, clinical examination; laboratory investigations, dorsolumbar plain x-ray and dual energy X-ray absorptiometry (DEXA) scan. Results: The children were 57.3% females and 42.7% males (F: M 1.3:1) with a mean age of 9.3 ± 2.7 years. The frequency of low BMD was 28.3% (n = 272), while 11.2% (n = 107) were osteoporotic. OP was idiopathic in 4.7% and secondary in 95.3%. In OP children there was history of vertebral fracture in 91, 2 long bone fractures in 13 and 3 long bone fractures in 3 following low impact traumas. The risk factors of OP were unhealthy nutrition (89.7%), anemia (87.9%), underweight (81.3%), bronchial asthma (68.2%), diabetes mellitus (58.9%), epilepsy (12.2%), delayed puberty (8.4%), chronic kidney disease (4.3%), rheumatic diseases (4.3%) and hypothyroidism (1.9%). There was a significant difference between those with and without OP as regards serum calcium, phosphorous, alkaline phosphatase (p < 0.001) and most common risk factors of OP among studied children (p ≤ 0.05). Conclusions: Osteoporosis is frequent in children and unhealthy nutrition is the most common risk factor. OP is frequent among chronic disease as anemia, diabetes mellitus, bronchial asthma and epilepsy. Raising awareness among rheumatologists, pediatricians and family medicine physicians about this alarming condition is warranted to early detect and treat cases.

Insufficient persistence of and adherence to osteoporosis pharmacotherapy in Japan.

Only a few large-scale studies have examined the care gap in Japan. The aim of this study was to investigate the persistence of and adherence to osteoporosis pharmacotherapy in Japan. The rates of continuation (persistence) of and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data, issued from July 2013 to December 2018, from the medical care system for elderly individuals in Hokkaido, Japan. The study included 7918 male and 52,585 female patients. Persistence rates were 62.1% in the first year and 45.3% in the second year. There were 33,096 patients who discontinued medication; 8296 patients resumed medication during the observation period of 730days. The median time to the discontinuation of medication for all the patients was 702days. The 2-year medication possession ratio (MPR) was 63.8%; 30,989 patients (51.2%) had an MPR ≥ 80% and 20,788 (34.4%) had an MPR < 50%. Both the persistence and adherence were better in females than in males and worsened with increasing age. Comparisons of fracture history showed that persistence and MPR were higher in the no hip or vertebral fracture group, followed by hip fracture, vertebral fracture, and hip and vertebral fracture groups. Meanwhile, more patients in the hip fracture group had an MPR ≥ 80%. Persistence of and adherence to osteoporotic pharmacotherapy are not very high in Japan. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those with a history of vertebral fracture.

Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial.

Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes. This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis). No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life. Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures. ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.

Transcultural adaptation and psychometric properties of the Korean version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41).

The aim of this study was to translate the QUALEFFO-41 for Korean patients and then validate the Korean version of QUALEFFO-41. Translation and transcultural adaptation of the QUALEFFO-41 was conducted according to the international recommendations. Ninety-seven patients (mean age, 73.6years) with osteoporosis were participated in validating the Korean version of QUALEFFO-41. To test reliability, internal consistency was evaluated using Cronbach's alpha coefficient. To test validity, convergent validity was assessed using correlation with the SF-12 and EQ-5D and discriminant validity was assessed using ROC curve analysis. The English version of QUALEFFO-41 was translated and adapted to Korean without notable discrepancies. The Korean QUALEFFO-41 had good reliability with Cronbach's alpha ranging from 0.733 to 0.942. QUALEFFO-41 had good correlations to SF-12 and EQ-5D. Compared with subjects without history of vertebral fracture (VF), those with history of VF showed significantly worse scores according to QUALEFFO-41, but not according to SF-12 or EQ-5D. ROC curve analysis revealed that the physical function domain of QUALEFFO-41 had significant ability to discriminate between subjects with and without history of VF, while SF-12 or EQ-5D did not. The Korean version of QUALEFFO-41 demonstrated relevant internal consistency, convergent validity, and discriminant validity, which can be recommended to evaluate quality of life in Koreans.

Relationship between X-ray findings of lumbar spondylosis and knee pain

BackgroundThe aim of this study was to investigate the correlation between radiographic measurement in lumbar spine and clinical information including symptoms or results of functional testing using a baseline data of longitudinal cohort study.MethodsA total of 314 elderly subjects were recruited from 5 orthopedic clinics or affiliated facilities. Data for the present investigation were collected via an interviewer-administered questionnaire, which included questions on past medical history, drug history, pain area. And also results of functional testing and X-ray imaging of the lumbar spine were collected. Analysis was carried out to determine any correlation between results of X-ray imaging of the lumbar spine and other collected data, and sorted regarding Akaike Information Criterion (AIC). The correlations among these variables and odds ratio were also analyzed.ResultsT12/L1% disc height showed a minimum AIC value with buttock pain (− 4.57) and history of vertebral fracture (− 4.05). The L1/L2, L2/L3, and L3/L4% disc height had a minimal AIC value with knee pain (− 4.11, − 13.3, − 3.15, respectively), and odds ratio of knee pain were 3.5, 3.8, and 2.7, respectively.ConclusionsCorrelation was recognized between the T12/L1% disc height and both buttock pain and previous vertebral fractures, and the L1/L2, L2/L3, and L3/L4% disc height showed a correlation with knee pain. Especially the L2/L3% disc height and knee pain had a strong correlation. It was suggested that these findings may provide additional basis to the concept that lumbar spinal lesion associates with knee pain clinically.

Exercise for improving outcomes after osteoporotic vertebral fracture.

Exercise for improving outcomes after osteoporotic vertebral fracture.

Effect of a resistance and balance exercise programme for women with osteoporosis and vertebral fracture: study protocol for a randomized controlled trial

BackgroundOsteoporotic vertebral fractures are common, and are associated with reduced functioning and health related quality of life. The primary aims of this randomized controlled trial are to examine the immediate and long-term effects of a 12-weeks supervised group exercise programme on habitual walking speed in older women with osteoporosis and a history of vertebral fracture. The secondary aims are to examine the immediate and long-term effects of the exercise program on physical fitness, fear of falling and quality of life.MethodsThe study is a single-blinded randomized controlled trial. Women aged 65 years or older with osteoporosis and a history of vertebral fracture are included. The intervention group receives a 12-week multicomponent exercise programme, including resistance training combined with balance training. The control group receives usual care. Adherence to the programme will be of importance for the internal validity of the study. Participants in the exercise group who don’t attend will be followed up with motivational phone calls. The primary outcome is habitual walking speed over 10 m. Secondary outcomes are health related quality of life (Qualeffo-41, SF-36), physical activity (I-PAQ), Patient Specific Functional Scale, Fear of falling (FES-1) and physical fitness (Senior Fitness test, Functional reach test, 4 square step test, grip strength). Sample size, based on the primary outcome, is 150 participants randomized into the two arms on a 1:1 allocation, including an estimated 20% drop out. Descriptive data will be reported as mean (standard deviation), median (range) or count (percent) as appropriate. The data will be analysed following the intention-to-treat principle. Between group differences in primary and secondary outcomes at 3 months follow-up will be assessed using linear regression models with respective outcome at baseline as covariate and the randomised group as factor.DiscussionThis trial will generate new knowledge on the effects of a multicomponent exercise programme among women over 65 years with osteoporosis and a history of vertebral fracture, knowledge that is of importance for clinicians, health managers and policy makers.Trial registrationClincialTrials.gov Identifier: NCT02781974. Registered 18.05.16. Retrospectively registered.

Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1).&#x0D; Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1).&#x0D; Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1).&#x0D; Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Patterns of Vertebral Pain Syndromes in Women of Older Age Groups Depending on Duration of Postmenopausal Period and Bone Mineral Density Score

The present study analyzes the frequency (prevalence rates) of vertebral pain syndrome (VPS) in 2844 women aged 40–89 years divided into groups based on the reproductive, perimenopausal and postmenopausal (PMP) stages of life and evaluates the relationship between the VPS rates and scores of bone mineral density (BMD). The overall VPS rates range from 84.1 to 94.4% throughout the different physiological stages of woman’s life, with a statistically significant increase in the PMP stage of 20 years duration or longer when compared with the reproductive and early postmenopausal stages. Significant growth of the VPS rates in the thoracic and lumbar regions of spine begins in the first to third years of PMP period (stage); the frequency remains high throughout all subsequent periods of PMP. Postmenopausal women are found to demonstrate a significant increase in the relative risk of developing VPS in the thoracic (1.3- to 1.4-fold) and lumbar (1.2- to 1.3-fold that) regions of the spine. Patients with osteoporosis in 1–3 years of PMP duration display significantly higher rates of VPS in the thoracic spine than women with osteopenia, while patients with 7–9 years of PMP duration have significantly increased rates as compared with groups that include osteopenia and norms. In patients with osteoporosis and no history of vertebral fractures, the VPS prevalence rates in the thoracic spine significantly increase in PMP periods of 4–6 and 7–9 years duration as compared with women in the reproductive stage, as well as in women with normal BMD scores. The identified VPS patterns can be of value in the planning of therapeutic interventions in women of senior age groups.

Predicting the progression of vertebral fractures in patients with multiple myeloma

Background ContextPatients with multiple myeloma (MM) incur significant degradation in quality of life because of progressive osteolytic vertebral fractures. No studies have investigated predictors of fracture progression, and limited data are available for predicting the development of future fractures. PurposeThe purpose of this study was to identify independent predictors of vertebral fracture progression and the development of future vertebral fracture. Study Design/SettingThis is a consecutive retrospective chart review at a single tertiary-care center. Patient SamplePatients with MM and pathologic vertebral fracture with radiographic follow-up between January 2007 and December 2013 were included. Radiographic measurements were recorded at presentation with fracture and first follow-up (FFU) after at least three months. Patients with a history of vertebral fracture not associated with MM were excluded. Outcome MeasuresThe primary outcome measure was the rate of vertebral body height loss. The development of future vertebral fracture was secondary. MethodsAnterior, middle, and posterior vertebral body heights were measured from midline sagittal T1-weighted magnetic resonance imaging (MRI). Future fracture-free survival was calculated using Kaplan-Meier analysis. Multivariable regression was used to identify independent predictors of the rate of vertebral height loss. Multivariable Cox proportional hazards modeling was used to identify predictors of developing future vertebral fracture. ResultsThirty-three patients with 67 fractures were followed for a median of 10.8 months to FFU. Sixty-four percent of the patients were female and the median age was 66. The median additional vertebral height loss between presentation and FFU was 15%, whereas the median rate of vertebral height loss was 1.01%/month. More rapid vertebral height loss was predicted by dyslipidemia (β=0.36, p=.05), previous non-vertebral pathologic fracture related to MM (β=0.51, p=.01), and Durie-Salmon Stage III (β=0.66, p=.06). The median time to future fracture was 25.1 months; the 5-year future fracture-free survival rate was 34%. Osteopenia/osteoporosis (hazard ratio [HR]: 9.28, p<.01), serum light chains (HR: 1.37, p=.06), and serum calcium (HR: 1.62, p=.05) predicted the development of future vertebral fracture. ConclusionsWe observed significant fracture progression over a short follow-up period. Several comorbidities and laboratory measures predicted more rapid vertebral height loss and the development of future fracture. Identifying risk factors for increased fracture burden may allow spine specialists to pursue earlier and appropriate intervention to optimize function and minimize morbidity.

Radiographic progression of vertebral fractures in patients with multiple myeloma

Background ContextNearly 70% of patients with multiple myeloma (MM) experience vertebral fracture. As a consequence, these patients suffer significantly poorer quality of life. However, no studies have characterized the natural progression of these fractures. PurposeThe purpose of this study was to characterize the progression of MM-associated vertebral fractures. Study Design/SettingA consecutive retrospective chart review at a single tertiary-care center was carried out. Patient SamplePatients with MM and pathologic vertebral fracture with at least one follow-up between January 2007 and December 2013 were included. Radiographic measurements were recorded until last follow-up (LFU) or until surgical intervention or patient death. Patients with a history of vertebral fracture not associated with MM were excluded. Outcome MeasuresThe primary outcome measure was change in height of the fractured vertebrae. Fractures were characterized by Genant grade and morphology. MethodsAt baseline and each follow-up, anterior, middle, and posterior vertebral body heights were measured from midline sagittal T1-weighted magnetic resonance imaging. Student t tests and Fisher exact tests were performed to identify variables associated with fracture progression. ResultsAmong 33 patients, 67 fractures were followed. Sixty-four percent of patients were female, with a mean age of 66. Baseline mean anterior, middle, and posterior vertebral body height losses were 30%, 36%, and 15%, respectively. Forty-three percent of fractures were Genant grade 3, and 57% were biconcave. Mean time to LFU was 40 months. At LFU, mean anterior, middle, and posterior vertebral body height losses increased to 47% (p<.01), 49% (p<.01), and 28% (p<.01), respectively. More fractures became Genant grade 3 (75%, p<.01) and wedge (54%, p=.03). On average, patients lost 0.83% in vertebral body height per month, with initial Genant grade 1 fractures progressing most rapidly (1.69%/month, p<.01). Patients treated with bisphosphonates suffered less additional height loss compared with untreated patients (14% vs. 24%, p=.07). ConclusionsWe observed significant fracture progression despite high utilization of bisphosphonates. Patients lost nearly 1% of additional vertebral body height per month, with the least severe presenting fractures progressing most rapidly, highlighting the necessity for early referral to spine specialists and evidence-based guidelines for surveillance and treatment in the myeloma population.

Risk of low bone mineral density in patients with rheumatoid arthritis treated with biologics.

BackgroundOsteoporosis is a complication of rheumatoid arthritis (RA). We identified risk factors for osteoporosis during treatment with biologics.MethodsFemoral neck bone mineral density (BMD) was measured in 186 patients with biologics-treated RA. We compared the characteristics of those with BMD ≥70 % of young adult mean (YAM) and those with BMD <70 % of YAM, and undertook multivariable logistic regression analysis to identify risk factors for bone loss.ResultsMean age and disease duration, the proportion of females, scores in the Modified Health Assessment Questionnaire and history of vertebral fracture were significantly greater in the BMD <70 % of YAM group, but body mass index (BMI) was significantly lower in the BMD <70 % of YAM group. There was no significant difference between the groups in terms of other biomarkers of RA activity, the proportion treated with methylprednisolone, or the duration or choice of biologics. The proportions of patients treated with anti-osteoporosis drugs and parathyroid hormone were significantly higher in the BMD <70 % of YAM group. In the multivariable analysis, advanced age, female, longer disease duration, history of past thoracic or lumbar vertebral fracture, higher Steinbrocker classification and lower BMI were significant factors for BMD <70 % of YAM.DiscussionWe identified risk factors for bone loss in patients with RA treated with biologics. Before suppression of disease activity by biologics, bone loss might already be advanced.ConclusionsWe recommend that patients with RA who possess these risk factors be considered for earlier and more intense treatment to prevent bone loss, as well as addressing RA disease progression.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0732-x) contains supplementary material, which is available to authorized users.