Predictors of residual low back pain after acute osteoporotic compression fracture

Chronic Pain and Bone-Related Pathologies: A Narrative Review

Purpose

Pain related to bone may occur as a result of trauma, bone fracture, genetic disease, arthritis, benign or malignant primary bone tumors and bone cancer metastases. We discuss the pathophysiology of chronic bone-related pain, treatment options and therapeutic perspectives.

Methods

Using predefined terms, we searched PubMed, MEDLINE, and Google Scholar for meta-analyses, evidence-based reviews, and clinical practice guidelines. This narrative article reviews pathologies linked to chronic bone pain and discusses the preventive and therapeutic strategies for better bone pain management.

Results

Pathophysiology of bone-related pain is complex, especially in cancer conditions and missing gaps are underlined. Treatment of pain, after adequate evaluation, includes classical analgesics, adjuvants for neuropathic and refractory pain, specific bone drugs, surgery and non-pharmacological approaches. Prevention of chronic bone pain encompasses prevention of central sensitization and of causal diseases.

Conclusion

Translational research, drug repurposing, an interdisciplinary approach and a person-centered assessment to evaluate, beyond pain, physical, social and functional abilities, are proposed future directions to improve chronic bone pain management and optimize independence and quality of life.

Summary

Chronic bone-related pain is frequent and is associated with an impairment of quality of life. In this review, we summarize the pathophysiology of chronic bone pain, describe treatment approaches and envisage new avenues for pain alleviation. Our article will help doctors manage chronic bone pain and address unmet needs for future research to alleviate bone-related pain.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Effectiveness of bone-filled mesh bag technology and angle vertebroplasty in the treatment of osteoporotic thoracic vertebral compression fractures in the elderly

OBJECTIVE

To evaluate the effectiveness, pain level, and lung function in elderly patients with osteoporotic thoracic vertebral compression fractures using bone filling mesh bag technology compared to curved vertebroplasty.

METHODS

This retrospective analysis reviewed 72 elderly patients with osteoporotic thoracic vertebral compression fractures treated at Xindu District People's Hospital of Chengdu between February 2021 and January 2022. The patients were separated into two groups according to surgery approach: an observation group using bone filling mesh bag technology and a control group using curved vertebroplasty. The overall response rate, pain degree, pulmonary function, life quality grades, surgical indicators, and bone cement leakage rates of the two groups were evaluated.

RESULTS

The variation in overall response rate (P=0.420), pain degree (P=0.270), pulmonary function (peak expiratory flow: P=0.660, forced expiratory volume in the first second: P=0.775, forced vital capacity: 0.062), and life quality grades (physical health: P=0.949, social function: P=0.935, physiological function: P=0.970, vitality: P=0.778) between the observation group and the control group after treatment was not statistically meaningful. The Cobb angle (P<0.001) and vertebral height (P<0.001) of patients in the observation group were significantly higher than those in the control group after therapy. The leakage rates of bone cement (intervertebral disc leakage, paravertebral vein leakage, paravertebral soft tissue leakage) of patients in the observation group were notably lower than those in the control group after therapy (P=0.029).

CONCLUSION

Bone filling mesh bag technology offers significant improvements in Cobb angle and vertebral height for treating elderly patients with osteoporotic thoracic vertebral compression fractures, and reduced the leakage rate of bone cement. This technique achieves comparable therapeutic outcomes to curved vertebroplasty.

Constructing a Deep Learning Radiomics Model Based on X-ray Images and Clinical Data for Predicting and Distinguishing Acute and Chronic Osteoporotic Vertebral Fractures: A Multicenter Study

RATIONALE AND OBJECTIVES

To construct and validate a deep learning radiomics (DLR) model based on X-ray images for predicting and distinguishing acute and chronic osteoporotic vertebral fractures (OVFs).

METHODS

A total of 942 cases (1076 vertebral bodies) with both vertebral X-ray examination and MRI scans were included in this study from three hospitals. They were divided into a training cohort (n = 712), an internal validation cohort (n = 178), an external validation cohort (n = 111), and a prospective validation cohort (n = 75). The ResNet-50 model architecture was used for deep transfer learning (DTL), with pre-training performed on RadImageNet and ImageNet datasets. DTL features and radiomics features were extracted from lateral X-ray images of OVFs patients and fused together. A logistic regression model with the least absolute shrinkage and selection operator was established, with MRI showing bone marrow edema as the gold standard for acute OVFs. The performance of the model was evaluated using receiver operating characteristic curves. Eight machine learning classification models were evaluated for their ability to distinguish between acute and chronic OVFs. The Nomogram was constructed by combining clinical baseline data to achieve visualized classification assessment. The predictive performance of the best RadImageNet model and ImageNet model was compared using the Delong test. The clinical value of the Nomogram was evaluated using decision curve analysis (DCA).

RESULTS

Pre-training resulted in 34 and 39 fused features after feature selection and fusion. The most effective machine learning algorithm in both DLR models was Light Gradient Boosting Machine. Using the Delong test, the area under the curve (AUC) for distinguishing between acute and chronic OVFs in the training cohort was 0.979 and 0.972 for the RadImageNet and ImageNet models, respectively, with no statistically significant difference between them (P = 0.235). In the internal validation cohort, external validation cohort, and prospective validation cohort, the AUCs for the two models were 0.967 vs 0.629, 0.886 vs 0.817, and 0.933 vs 0.661, respectively, with statistically significant differences in all comparisons (P < 0.05). The deep learning radiomics nomogram (DLRN) was constructed by combining the predictive model of RadImageNet with clinical baseline features, resulting in AUCs of 0.981, 0.974, 0.895, and 0.902 in the training cohort, internal validation cohort, external validation cohort, and prospective validation cohort, respectively. Using the Delong test, the AUCs for the fused feature model and the DLRN in the training cohort were 0.979 and 0.981, respectively, with no statistically significant difference between them (P = 0.169). In the internal validation cohort, external validation cohort, and prospective validation cohort, the AUCs for the two models were 0.967 vs 0.974, 0.886 vs 0.895, and 0.933 vs 0.902, respectively, with statistically significant differences in all comparisons (P < 0.05). The Nomogram showed a slight improvement in predictive performance in the internal and external validation cohort, but a slight decrease in the prospective validation cohort (0.933 vs 0.902). DCA showed that the Nomogram provided more benefits to patients compared to the DLR models.

CONCLUSION

Compared to the ImageNet model, the RadImageNet model has higher diagnostic value in distinguishing between acute and chronic OVFs. Furthermore, the diagnostic performance of the model is further improved when combined with clinical baseline features to construct the Nomogram.

Therapeutic effects of single versus bilateral approaches for percutaneous kyphoplasty in osteoporotic compression fractures

the clinical effectiveness of unilateral/bilateral percutaneous vertebral augmentation (PVA) for the treatment of osteoporotic vertebral compression fractures (OVCF) was assessed to provide guidance for clinical treatment.Through retrospective analysis of data from 107 patients, including preoperative and postoperative visual analogue scale scores, bone cement leakage, adjacent vertebral fractures, vertebral height, and infection.There was no significant difference in preoperative and postoperative scores, Cobb angle, anterior height, and bone cement leakage rate, but the vertebral body height in the bilateral percutaneous vertebral fusion surgery group was significantly higher than that in the unilateral group(P < 0.05).Grade I compression fractures, a unilateral PVA approach was recommended, while for Grade II and III compression fractures, a bilateral PVA approach was preferable.

Depression, catastrophizing, and poor performance in women with persistent acute low back pain from vertebral compression fractures: A prospective study

BACKGROUND

Research on the multi-faceted characteristics of persistent severe acute lower back pain (LBP) resulting from acute vertebral compression fractures (VCFs) is lacking.

OBJECTIVE

To investigate the psychological and functional status of older patients with persistent severe acute LBP after conservative treatment of VCFs.

METHODS

This prospective study included women aged 50 years and older who had acute VCFs and were admitted to the hospital. Pain intensity, depression, pain catastrophizing, activities of daily living (ADL), muscle strength, and vertebral deformity were assessed on admission. At 2 and 4 weeks post-admission, physical performance tests were performed along with the above measures.

RESULTS

We divided 131 participants into severe (n= 64) and mild (n= 67) groups according to their pain intensity at 4 weeks. Compared to the mild group, the severe group showed significantly higher levels of depression and catastrophizing, with significantly poorer muscle strength and endurance. There were no significant differences in ADL and vertebral deformities between the two groups.

CONCLUSIONS

Our results suggest that older patients with persistent severe acute LBP resulting from VCFs tend to be depressed and pain catastrophizing. Furthermore, persistent severe acute LBP negatively impacts endurance and muscle strength but not ADL.

The real‐world effect of 12 months of romosozumab treatment on patients with osteoporosis with a high risk of fracture and factors predicting the rate of bone mass increase: A multicenter retrospective study

Excluding clinical trials, there is limited evidence on the effect of 12 months of romosozumab treatment on bone mineral density (BMD) increase in real‐world clinical practice because its use has only been approved recently. Thus, this study aimed to investigate the real‐world effect of 12 months of romosozumab treatment on BMD increase and identify factors that predict the rate of BMD increase after 12 months of romosozumab treatment. We retrospectively investigated 106 patients who completed a 12‐month romosozumab treatment for osteoporosis with a high risk of fractures at four hospitals from March 2020 to March 2022. The univariate and multiple regression analyses were performed to analyze the concurrent effects of various factors on the BMD increase after the 12‐month romosozumab treatment. After 1 year of treatment, the lumbar spine BMD increased by 14.6%, and femoral neck BMD increased by 5.1%. Univariate regression analysis found that male sex, high tartrate‐resistant acid phosphatase 5b (TRACP‐5b) value before romosozumab administration, absence of osteoporosis medications before romosozumab administration, and low baseline lumbar spine BMD were associated with the extent of lumbar spine BMD increase. Moreover, stepwise multiple regression analysis found that the TRACP‐5b value before romosozumab administration was a significant predictor of the rate of lumbar spine BMD increase after 1 year of romosozumab administration. In conclusion, our results demonstrated the effectiveness of the 12‐month romosozumab treatment for osteoporosis with a high risk of fractures and the TRACP‐5b value before romosozumab administration was a significant predictor of the rate of lumbar spine BMD increase after 1 year of romosozumab administration. Our findings could help establish more efficient treatment strategies for patients with osteoporosis at a high risk of fracture. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Background

A retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs).

Methods

From January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41).

Results

Visual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C.

Conclusion

Compared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.