Osteoporosis Vertebral Fractures Research Articles

Correlation between serum HDL/LDL and t-PINP /β-CTX and osteoporotic vertebral fractures in elderly women

To explore high density lipoprotein (HDL)/low density lipoprotein (LDL) and total typeⅠcollagen amino terminal extender peptide (t-PINP)/ C-terminal peptide of typeⅠcollagen β special sequence(β-CTX)and risk of osteoporosis vertebral fractures (OPVFs) in elderly women. The clinical data of 446 female OPVFs patients aged above 60 years old from January 2019 to December 2020 were retrospectively analyzed. According to whether or not fracture, patients were divided into non-fracture group (186 patients) and fracture group(260 patients). Univariate analysis was performed to analysis age, body mass index(BMI), N-terminal mioldle molecular fragment of osteocalcin, N-MID OC), t-PINP, β-CTX, 25-hydroxyvitamin D[25-(OH) VitD], blood sugar (Glu), total cholesterol(TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), Ca, P, Mg, urea (UREA), creatinine (Cr) and Cystatin C(CysC), and correlation between OPVFs and the above indexes and lipid, bone metabolism indexes between two groups;Logistic regression was performed to analyze risk factors and stratification relationship between vertebral fracture and HDL/LDL, t-PINP/β-CTX. Logistic regression was used to analyze risk factors and stratification relationship between OPVFs and HDL/LDL, t-PINP/β-CTX. There were no significant difference in age and BMI between non-fracture group and fracture group (P>0.05). Compared with non-fracture group, contents of HDL, t-PINP/β-CTX and HDL/LDL in fracture group were decreased, and contents of β-CTX were increased (P<0.05). OPVFs was positively correlated with β-CTX (r=0.110, P<0.05), and negatively correlated with HDL, HDL/LDL and t-PINP/β-CTX (r=-0.157, -0.175, -0.181, P<0.05). HDL and HDL/LDL were negatively correlated with β-CTX (r=-0.22, -0.12, P<0.05) and t-PINP (r=-0.13, -0.10, P<0.05). 25-(OH) VitD was positively correlated with TC and HDL (r=0.11, 0.18, P<0.05). HDL/LDL was positively correlated with t-PINP/β-CTX(r=0.11, P=0.02). t-PINP/β-CTX[OR=0.998, 95%CI(0.997, 1.000), P<0.05], HDL/LDL[OR=0.228, 95%CI(0.104, 0.499), P<0.01] were risk factors for vertebral fracture. The lower levels between two tristratified indicators, the higher the vertebral fracture rate. The risk of fracture was 2.5 and 2 times higher in the lowest stratum than in the highest stratum, with an adjusted OR was[2.112, 95%CI(1.310, 3.404)] and [2.331, 95%CI(1.453, 3.739)], respectively. Serum low HDL/LDL and t-PINP /β-CTX are independent risk factors for OPVF in elderly women, and have good predictive value for OPVF risk.

Clinical diagnosis of vertebral fractures in osteoporosis (literature review)

Background. Osteoporosis is a common pathology among older age groups. Vertebral fractures are one of the most severe complications of osteoporosis, as they lead to a decrease in the quality of life, disability and increased mortality. The risk of vertebral fractures increases with age, especially in those who have already has a fracture of this localization. To improve the prognosis in this category of patients, early detection, treatment of patients with fractures, as well as prevention of new fractures, are important. At the same time, the diagnosis of osteoporotic vertebral fractures presents certain difficulties due to the variability of their clinical manifestations, which often leads to insufficient detection, wrong diagnosis and, as a consequence, to the lack of adequate treatment.Purpose of the review. To conduct a literature search to evaluate the clinical diagnosis of osteoporotic vertebral fractures.Conclusion. There was no single highly specific and at the same time sensitive clinical symptom of osteoporotic vertebral fractures. Back pain remains a relatively nonspecific symptom in vertebral fractures. The most specific symptoms: kyphosis and height loss have a high predictive value only when they are significantly changed. Thus, vertebral fractures should be suspected if height decreased more than 2.0 cm per year or more than 4.0 cm per life, if the patient does not reach the wall with his head or if the «rib to pelvis» distance is two fingers or less. The combination of clinical symptoms with the assessment of risk factors and bone mineral density has the greatest clinical significance. If a vertebral fracture is clinically suspected, it is advisable to perform an X-ray of the thoracic and lumbar spine, since the localization of pain indicated by the patient may not correspond to the localization of the fracture.

Image classification of osteoporotic vertebral fracture with endplate-disc complex Injury

BackgroundThe purpose of this study was to use MRI and CT to observe osteoporosis vertebral fracture (OVF) combined with endplate-disc complex (EDC) injury and to classify the degree of EDC injury according to the changes in EDC signal intensity and morphology on the images.MethodsWe investigated the incidence of EDC injury, observed the morphology and signal intensity changes of EDC injury using MRI and CT, and graded the injuries from 0 to 4 according to their severity. We compared whether there were differences in the degree of EDC injury among different vertebral fractures, bone mineral density(BMD), and severity of vertebral fractures.ResultsA total of 479 patients were included in this study, of whom 321 had EDC injury adjacent to the fractured vertebral body. Among those, 158 cases were grade 0, 66 cases were grade 1, 72 cases were grade 2, 78 cases were grade 3, and 92 cases were grade 4. The degree of EDC injury associated with thoracolumbar vertebral fractures was more serious than that of EDC injuries associated with thoracic and lumbar vertebral body fractures. Vertebral fractures with severe osteoporosis were associated with more severe EDC injury. Additionally, the more severe the vertebral fracture, the more severe was the combined EDC injury.ConclusionThis study found that the incidence rate of EDC injury reached 67.0%. Among patients with OVF, severe osteoporosis and severe fractures in the thoracolumbar segments were often associated with more severe EDC injury.

Effectiveness and reliability of cannulated fenestrated screws augmented with polymethylmethacrylate cement in the surgical treatment of osteoporotic vertebral fractures.

Background:Implants' stability, especially in osteoporosis patients, is a challenging matter. Nowadays, the adoption of cannulated fenestrated screws augmented with polymethylmethacrylate cement (PMMA CSF) is described by some authors. This single-center, retrospective observational study aims to evaluate the long-term effectiveness, reliability, and mechanical performances of this type of screws in osteoporotic fractures.Materials and Methods:All the patients surgically treated from January 2009 to December 2019 with PMMA CSF were evaluated and submitted to the inclusion and exclusion criteria. Clinical and radiological evaluations were performed at pre- and post-surgery time and at the follow-up (FU). Loss of correction in the sagittal plane (bisegmental Cobb angle), kyphosis angle of the fracture (fractured vertebral angle), loosening of pedicle screws (screw's apex vertebral body's anterior cortex mean gap called SAAC gap and screw's apex vertebral body's superior endplate mean gap called SASE gap), visual analog scale, and Oswestry disability index scores were evaluated.Results:One hundred and sixty-three patients (58 males and 105 females) aged over 65 years affected by vertebral osteoporotic fractures were included in the study. At FU, we do not found significant differences in radiological items in respect to the postoperative period. Only one case of loosening and 18 cases of cement leaking (without neurological impairments) were found. Clinical scores improvement was significant in the interval between preoperative and FU.Conclusions:PMMA CSF seems to can guarantee good efficacy and effectiveness in the surgical treatment of vertebral fractures in osteoporosis.

The effectiveness of mechanotherapeutic methods for spine deep stabilization system training in patients with osteoporotic vertebral fractures

The aim of the study was to estimate the effect of new physical rehabilitation complex using of mechanotherapeutic methods on spine muscle strength in patients with osteoporosis (OP) and vertebral fractures (VF). Material and methods: Study comprised of 90 osteoporotic patients aged 50-80 years old (65.4±9.1 years) with OP VFs who were randomized as 2:1 into intervention group (group1, n=60) and control group (group2, n=30). Patients in group 1 received an intensive rehabilitation course including back muscle training with mechanical loads #10; sensorimotor training on double unstable platform #10; kinesohydrotherapy in a pool #15; physical exercises in a gym #10. Group 2 was prescribed only physical exercises in a gym #15. All patients undergo tenzodynamometry on BackCheck diagnostic unit (Dr. Wolff, Germany) at baseline, in 3 weeks at the end of rehabilitation course and in a month of follow-up. Results: In group 1 after the rehabilitation course muscle strength improved in trunk extensors (TE) from 15.8±10.1 to 21.7±13.1 kg (p&lt;0.001), trunk flexors (TF) from 14.5±9.1 to 18.9±10.2 kg (p&lt;0.001), left lateral flexors (LLF) from 12.8±7.2 to 17.5±9.6kg (p&lt;0.001) and right lateral flexors (RLF) from 13.2 ± 7.1 to 17.8 ± 9.2 kg (p&lt;0.01). Strength deficiency significantly decreased in all muscles (p&lt;0.001 for TE and TF, p&lt;0.05 for LLF, p&lt;0.01 for RLF). The achieved effect lasted for a month of follow-up. In group 2 positive dynamics of strength was observed after 3 weeks only in TE and TF (p&lt;0.05), however, after a month of observation, the strength of all the studied muscles did not differ from the baseline (p&gt;0.05). Conclusion: The new 3-week complex of physical rehabilitation using of mechanotherapeutic methods lead to increase of spine muscle strength and improvement of muscle strength deficiency in patients with osteoporotic VFs. Rehabilitation effect lasts for at least a month after the treatment completion.

Back pain and spinal osteoporosis in clinical practice

Back pain is a common clinical and socioeconomic problem. Back pain is a symptom, not a nosological form. Osteoporosis is a skeletal disease in which, despite normal bone mineralization, bone loss and bone (structure) integrity is observed. The article considers the main causes of primary and secondary osteoporosis. The main modifiable and unmodifiable risk factors for osteoporosis and fractures are presented. The main pathological conditions and diseases associated with the risk of osteoporosis are described. The problem of osteoporosis of the spine as one of the causes of mechanical painful episodes in the back of elderly patients is considered in depth. Clinical features of compression vertebral fractures in osteoporosis in women after menopause are presented. The methods of conservative treatment of osteoporosis are considered. The greatest attention is paid to such effective antiosteoporotic drugs as bisphosphonates. The data on the efficacy and tolerability of alendronic acid preparations as the most studied preparation from the group of bisphosphonates are analyzed. The information on the new medicinal form of alendronic acid – sparkling soluble tablets (Binosto) is presented.

Men's experiences of having osteoporosis vertebral fractures: a qualitative study using interpretative phenomenological analyses.

There is a lack of research exploring the experience of osteoporosis from the male perspective. This study was undertaken to explore and describe the experiences of men with vertebral fractures due to osteoporosis, including their perceptions of diagnosis, treatment and changes in their sense of self. The study consists of in-depth semi-structured interviews with nine male participants of the PROVE (Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture) study. Interviews were digitally audio recorded and fully transcribed. Data were coded in accordance with an interpretative phenomenological analysis approach to analyses. Three main themes are presented. (i) Osteoporosis is considered an old women's disease. (ii) Men are diagnosed and treated differently than women in the NHS. Health care inequalities exist. (iii) Changes in self can occur in men after vertebral fracture/s due to osteoporosis. Greater awareness that men get this condition is needed in both society in general and also by health care professionals who often do not expect osteoporosis to affect men. Approaches to diagnosis and treatment need to be considered and improved to ensure that they become appropriate and effective for men as well as women.

Three cases of caudal screw back out after percutaneous pedicle screw for osteoporosis vertebral fracture

Three cases of caudal screw back out after percutaneous pedicle screw for osteoporosis vertebral fracture

Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations.

To evaluate the role of third generation percutaneous vertebral augmentation systems (Spine Jack®) as alternative to the corpectomies and expandable cages replacement (X-Core® Adjustable VBR System) in the treatment of vertebra plana (VP) as complication of the osteoporosis vertebral fracture (OVF). Spine Jack® is a new device for mechanical kyphoplasty (MK). It is a titanium implant designed to restore the height of the vertebral body in OVF, primary or secondary bone tumors, or traumatic fractures. The X-Core® adjustable VBR System is a vertebral body replacement device indicated for use in the thoracolumbar spine (T1 to L5). The preoperative radiographic exams, computed tomography (CT), and magnetic resonance imaging (MRI) were performed in all cases. Clinical outcome measures included preoperative and postoperative Oswestry Disability Index (ODI), Visual Analog Scale pain score (VAS), neurologic examination, complications, estimated blood loss, and operating time. Postoperative radiographic evaluations were made at 1, 6, and 12 months. The anterior and middle column reconstruction by Spine Jack represents a valid alternative to the corpectomy in the patients affected by VP, especially in case elderly and/or high operative risk. In case of Spine Jack use, the correct indications must be respected: the hyperintense signal in STIR MRI sequences to the level of the fractures must be present. The eventual posterior spinal cord compression represents a relative contraindication. In case it would be superior to 1/3 and 2/3 respectively in case of fractures level above and below the spinal cord, a direct posterior spinal cord decompression must be performed. Avoiding the corpectomy, it is possible to reduce the operating time and the associated risks, as well as reducing blood loss.

Spontaneous Corpectomy and Anterior Arthrodesis in Lumbar Spine : How Ankylosing Spondylitis Can Resolve a Vertebral Fracture

Between the 80% and 90% of vertebral fractures in over 65 years people are due to osteoporosis. Over the 30% of patients affected by vertebral osteoporosis fractures needs of surgical treatment and the 12% presents complications requiring an invasive surgical approach. We report an unusual case of spontaneous corpectomy and anterior arthrodesis occurred in a patient suffering from Ankylosing Spondylitis. This event invites us to reflect about the magnitude of the biological power of the bone healing, even in adverse conditions

PMD9 - Economic Study of Non-Pharmacological and Pharmacological Treatment for Osteoporosis Vertebral Fracture and Bone Events in Oncology Patients in a Health Insurance Provider in a Latin America Country

PMD9 - Economic Study of Non-Pharmacological and Pharmacological Treatment for Osteoporosis Vertebral Fracture and Bone Events in Oncology Patients in a Health Insurance Provider in a Latin America Country

Impaired bone material properties increase the risk of all fractures and severity of vertebral fractures in osteoporosis: an impact microindentation study

Impaired bone material properties increase the risk of all fractures and severity of vertebral fractures in osteoporosis: an impact microindentation study

EFFICACY OF PHYSICAL EXERCISES IN PATIENTS WITH OSTEOPOROTIC VERTEBRAL FRACTURES

Vertebral fractures in osteoporosis (OP) patients are accompanied by a decrease in quality of life (QoL) and functional limitations. Physical activity is often recommended for such patients to reduce pain, improve QoL, and functional status. Objective. To assess the impact of exercises on QOL, functional performance, and balance in patients with osteoporotic vertebral fractures. Material and Methods. The study included 78 women with vertebral fractures and chronic back pain (40 patients in the study group and 38 patients in the control group). The average age of patients in the study group was 70.7 ± 8.1 years; in the control – 67.6 ± 7.0 years (p = 0.35). The studied parameters did not significantly differ for two groups at the beginning of the study. In the study group, physical exercises were conducted for 40 minutes twice a week during 12 months. Patients in the control group were recommended to follow the same physical activity as it was prior to the study. Evaluation of the studied parameters at study baseline and 12 months later was carried out using the QUALEFFO-41 questionnaire, a computer system for disequilibrium diagnostics and the «Stand up and walk» test. Results. After 12 months, a statistically significant improvement in QoL was observed among patients of the study group, both in the total score (41.2) compared with the control (57.3, p<0.0001), and in values of all domains, as well as results of the «Rise from a sitting position» and «Chasse step» balance tests. After 12 months, the study group showed a statistically significant reduction of time required to execute the «Stand up and walk» test from 12.1 ± 3.8 to 10.8 ± 2.5 s (p = 0.028), while no changes were observed in the control group (11.1 ± 3.4 and 11.1 ± 2.8 s respectively). Exercises improve QoL, functional activity and balance in patients with osteoporotic vertebral fractures.

Long-term fracture rates seen with continued ibandronate treatment: pooled analysis of DIVA and MOBILE long-term extension studies

Ibandronate reduces the risk of vertebral and non-vertebral fractures versus placebo in postmenopausal women with osteoporosis. This analysis, in which fractures were reported as safety events, showed that long-term use of ibandronate was associated with low fracture rates over 5 years of treatment. A previous post-hoc meta-analysis of 2-3 year studies found that ibandronate regimens with annual cumulative exposure (ACE) of ≥10.8 mg reduced the risk of vertebral and nonvertebral fractures (NVFs) versus placebo in postmenopausal women. This post-hoc analysis used individual patient data from the 2-year monthly oral ibandronate in ladies (MOBILE) and dosing intravenous administration (DIVA) studies, including the 3-year long-term extensions (LTEs), to assess fracture risk in patients treated with ibandronate for 5 years. Patients treated for 2 years in MOBILE with monthly oral ibandronate 150 mg (n = 176) and in DIVA with IV ibandronate every 2 months 2 mg (n = 253) or quarterly 3 mg (n = 263) who continued on the same regimens for 3 additional years in the LTEs were included. Three-year placebo data (n = 1,924) were obtained from the ibandronate osteoporosis vertebral fracture trial in North America and Europe (BONE) and IV Fracture Prevention trials. The primary endpoint was clinical fracture rate; clinical fracture data were collected as adverse events. Time to fracture was analyzed using Kaplan-Meier and statistical analysis was conducted using the log-rank test. All clinical fractures included all NVFs and symptomatic vertebral fractures. For ibandronate regimens with ACE ≥10.8 mg, time to fracture was significantly longer for all clinical fractures, NVFs, and clinical vertebral fractures versus placebo (P = 0.005). For all fracture types, the rate of fracture appeared stable during the 5-year treatment period. In women with postmenopausal osteoporosis, continuous treatment with ibandronate over 5 years results in low sustained clinical fracture rate.

Intracardiac foreign body caused by cement leakage as a late complication of percutaneous vertebroplasty

Intracardiac foreign body caused by cement leakage as a late complication of percutaneous vertebroplasty

Bone Scintigraphy V.S. Conventional Radiography in Early Diagnosis of Compressive Vertebral Fractures in Osteoporosis

Bone Scintigraphy V.S. Conventional Radiography in Early Diagnosis of Compressive Vertebral Fractures in Osteoporosis

Ibandronate: A Review of its Vertebral and Nonvertebral Antifracture Efficacy

After the Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE) study had demonstrated the strong vertebral and nonvertebral antifracture efficacy of daily and intermittent oral ibandronate, the Monthly Oral Ibandronate In Ladies (MOBILE) study gave evidence for an increased efficacy on the bone mineral density (BMD) of higher intermittent oral ibandronate doses (150 mg monthly) compared with 2.5 mg daily. The BONE study also observed nonvertebral antifracture efficacy in patients with a high risk for fractures (mean femoral neck T score of -3.0 or less). A recently published meta-analysis assessing the nonvertebral antifracture efficacy corresponding to the annual cumulative exposure (ACE) of ibandronate demonstrated a significantly better antifracture efficacy of higher compared with lower doses of ibandronate. The Dosing Intravenous Administration (DIVA) study demonstrated evidence for the high efficacy and good tolerability of intravenous ibandronate delivered by quarterly injections. This review summarizes the efficacy and tolerability data of ibandronate concerning monthly oral treatment as well as quarterly injection therapy.

Prevention of vertebral fractures in osteoporosis: mixed treatment comparison of bisphosphonate therapies

ABSTRACTObjective: The objective was to compare the efficacy of bisphosphonates regarding the prevention of vertebral fractures in postmenopausal women with osteoporosis.Methods: Seven randomized placebo controlled trials investigating the effects of zoledronic acid (one study), alendronate (three studies), ibandronate (one study), and risedronate (two studies) in terms of fractures with a follow-up of 3 years were identified with a systematic literature search. The endpoint of interest was vertebral fractures. Results of all trials were analyzed simultaneously with a Bayesian mixed treatment comparison (MTC). With MTC the relative treatment effect of one intervention to another can be obtained in the absence of head-to-head evidence. MTC can be considered a valid method when included studies are comparable regarding effect modifying baseline patient and study characteristics.Results: There is a 98% probability that zoledronic acid shows the greatest reduction in vertebral fractures of all four bisphophonates compared. Zoledronic acid showed an OR of 0.28 (95% Credible Interval 0.22; 0.35) relative to placebo, an OR of 0.57 (0.36; 0.92) relative to ibandronate, an OR of 0.54 (0.39; 0.75) relative to alendronate, and an OR of 0.49 (0.34; 0.69) relative to risedronate. Alendronate, ibandronate, and risedronate showed comparable vertebral fracture reductions. Indirect comparisons using a conservative random effects model supported these findings.Conclusion: An indirect comparison of findings from placebo controlled randomized studies indicates that zoledronic acid provides a greater vertebral fracture risk reduction in postmenopausal women with osteoporosis than ibandronate, alendronate, or risedronate.

Oral Ibandronate Preserves Trabecular Microarchitecture: Micro-Computed Tomography Findings From the Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe Study

Micro-computed tomography (micro-CT) is a quantitative 3-dimensional (3D) scanning procedure used to assess trabecular architecture. In the 3-yr oral iBandronate Osteoporosis vertebral fracture trial in North America and Europe (BONE) study, it was found that oral ibandronate administered daily (2.5 mg) or intermittently (20 mg) significantly reduced vertebral fracture risk by 62% ( p = 0.0001) and 50% ( p = 0.0006), respectively, vs placebo. Two-dimensional histomorphometric analysis of BONE study biopsies indicated that newly formed bone was of normal quality. In the current analysis, micro-CT was used to assess 3D trabecular microarchitecture. Rod and plate distribution was quantified by differential analysis of the triangulated bone surface. Biopsies were obtained from 110 patients, with 84 evaluable by micro-CT. Median structural model index (SMI; a lower SMI indicates an increased ratio of plates to rods and thus, improved trabecular microarchitecture) was 1.001 with ibandronate vs 1.365 with placebo (90% confidence interval [CI] for difference in medians: –0.626, –0.033), and connectivity density was higher in ibandronate-treated patients (median: 3.904 vs 3.112/mm 3, 90% CI for difference in medians: 0.159, 1.517). This indicates that trabecular microarchitecture was better preserved in patients receiving ibandronate than placebo. Taken together with previous results from BONE, these findings indicate that ibandronate treatment preserves bone strength by maintaining good quality trabecular microarchitecture in women with postmenopausal osteoporosis.

Recent developments in the management of postmenopausal osteoporosis with bisphosphonates: enhanced efficacy by enhanced compliance

Bisphosphonates are the current mainstay of treatment for postmenopausal osteoporosis. Although daily oral dosing is effective, it is associated with poor compliance, partly because of the pre and postdose fasting and posture requirements. This negatively impacts treatment outcomes, leading to a reduced clinical benefit. Improved, yet still suboptimal adherence has been noticed with less frequent bisphosphonate dosing e.g. once-weekly and once-monthly oral regimens. The recently approved quarterly intravenous (i.v.) injection regimen of ibandronate and yearly i.v. infusion of zoledronic acid are attractive options in the management of postmenopausal osteoporosis. These regimens may assure quarterly and year long compliance.