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Hudson M, Meyer J, Evans A, Krishna C, Smith ZA, Bakhsheshian J. Evaluating osteoporosis and bone quality in the aging spine: modern considerations for surgical management in the geriatric population. GeroScience 2024; 46:5287-5301. [PMID: 38703277 PMCID: PMC11336023 DOI: 10.1007/s11357-024-01171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
Surgical management paradigms of spinal pathologies in the aging population carry inherent substantial risks, with surgical complications being more prevalent among patients with osteoporosis compared to those with normal bone mineral density. In this narrative review, we aim to highlight important clinical understanding and considerations in perioperative evaluation and management of patients elected to undergo spinal surgery. Osteoporosis is a well-defined risk factor for mechanical complications following spinal surgery, and as such, perioperative optimization of bone health in the setting of surgery for geriatric patients remains a critical research area alongside intraoperative surgical augmentation techniques. Surgical techniques to circumvent challenges with instrumentation of poor bone mineral density have included augmentation of pedicle screw fixation, including segmental bicortical screw fixation techniques, cement augmentation with fenestrated screws, or use of expandable pedicle screws to improve bone-implant interface. Judicious selection of treatment modalities and subsequent perioperative optimization is paramount to minimize surgical complications. Contemporary guidelines and evolving paradigms in perioperative evaluation, optimization, and management of the aging spine include the advent of quantitatively evaluating computed tomography (CT) via assessment of the magnitude of Hounsfield units. Prescribing pharmacotherapeutic agents and monitoring bone health requires a multidisciplinary team approach, including endocrinologists and geriatricians to coordinate high-quality care for advanced-age patients who require surgical management of their spinal disorders.
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Affiliation(s)
- Miles Hudson
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
| | - Jenna Meyer
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Alexander Evans
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Arana E. [Translated article] Diagnostic imaging in patients with vertebral compression fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00143-7. [PMID: 39128695 DOI: 10.1016/j.recot.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 08/13/2024] Open
Abstract
Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are intravertebral fluid collection or fluid signal, other vertebral deformities without oedema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.
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Affiliation(s)
- E Arana
- Servicio de Radiodiagnóstico, Fundación IVO, Red Española de Investigadores en Dolencias de la Espalda (REIDE), Valencia, Spain.
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Wanionok NE, Morel GR, Fernández JM. Osteoporosis and Alzheimer´s disease (or Alzheimer´s disease and Osteoporosis). Ageing Res Rev 2024; 99:102408. [PMID: 38969142 DOI: 10.1016/j.arr.2024.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
Alzheimer's disease (AD) and osteoporosis are two diseases that mainly affect elderly people, with increases in the occurrence of cases due to a longer life expectancy. Several epidemiological studies have shown a reciprocal association between both diseases, finding an increase in incidence of osteoporosis in patients with AD, and a higher burden of AD in osteoporotic patients. This epidemiological relationship has motivated the search for molecules, genes, signaling pathways and mechanisms that are related to both pathologies. The mechanisms found in these studies can serve to improve treatments and establish better patient care protocols.
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Affiliation(s)
- Nahuel E Wanionok
- Laboratorio de Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Cs. Exactas. Universidad Nacional de La Plata UNLP-CIC, Argentina
| | - Gustavo R Morel
- Biochemistry Research Institute of La Plata "Professor Doctor Rodolfo R. Brenner" (INIBIOLP), Argentina
| | - Juan M Fernández
- Laboratorio de Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Cs. Exactas. Universidad Nacional de La Plata UNLP-CIC, Argentina.
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J O, S L, S G, B H, S M N. An overview of the performance of AI in fracture detection in lumbar and thoracic spine radiographs on a per vertebra basis. Skeletal Radiol 2024; 53:1563-1571. [PMID: 38413400 PMCID: PMC11194188 DOI: 10.1007/s00256-024-04626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. METHODS Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. RESULTS A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. CONCLUSION Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures.
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Affiliation(s)
- Oppenheimer J
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany.
| | - Lüken S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Geveshausen S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Hamm B
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Niehues S M
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
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Arana E. Diagnostic imaging in patients with vertebral compression fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00093-6. [PMID: 38878884 DOI: 10.1016/j.recot.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are Intravertebral fluid collection or fluid signal, other vertebral deformities without edema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.
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Affiliation(s)
- E Arana
- Servicio de Radiodiagnóstico. Fundación IVO, Valencia. Red Española de Investigadores en Dolencias de la Espalda (REIDE), España.
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Xue C, Sun G, Wang N, Liu X, He G, Wei Y, Xi Z. Value of Hounsfield units measured by chest computed tomography for assessing bone density in the thoracolumbar segment of the thoracic spine. Asian Spine J 2024; 18:336-345. [PMID: 38917853 PMCID: PMC11222884 DOI: 10.31616/asj.2023.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 06/27/2024] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE To investigate the correlation between Hounsfield unit (HU) values measured by chest computed tomography (CT) and dual-energy Xray absorptiometry (DXA) T-scores. HU-based thoracolumbar (T11 and T12) cutoff thresholds were calculated for a cohort of Chinese patients. OVERVIEW OF LITERATURE For patients with osteoporosis, the incidence of fractures in the thoracolumbar segment is significantly higher than that in other sites. However, most current clinical studies have focused on L1. METHODS This retrospective study analyzed patients who underwent chest CT and DXA at our hospital between August 2021 and August 2022. Thoracic thoracolumbar segment HU values, lumbar T-scores, and hip T-scores were computed for comparison, and thoracic thoracolumbar segment HU thresholds suggestive of potential bone density abnormalities were established using receiver operating characteristic curves. RESULTS In total, 470 patients (72.4% women; mean age, 65.5±12.3 years) were included in this study. DXA revealed that of the 470 patients, 90 (19%) had osteoporosis, 180 (38%) had reduced osteopenia, and 200 (43%) had normal bone mineral density (BMD). To differentiate osteoporosis from osteopenia, the HU threshold was established as 105.1 (sensitivity, 54.4%; specificity, 72.2%) for T11 and 85.7 (sensitivity, 69.4%; specificity, 61.1%) for T12. To differentiate between osteopenia and normal BMD, the HU threshold was 146.7 for T11 (sensitivity, 57.5%; specificity, 84.4%) and 135.7 for T12 (sensitivity, 59.5%; specificity, 80%). CONCLUSIONS This study supports the significance of HU values from chest CT for BMD assessment. Chest CT provides a new method for clinical opportunistic screening of osteoporosis. When the T11 HU is >146.7 or the T12 HU is >135.7, additional osteoporosis testing is not needed unless a vertebral fracture is detected. If the T11 HU is <105.1 or the T12 HU is <85.7, further DXA testing is strongly advised. In addition, vertebral HU values that fall faster than those of the T11 and L1 vertebrae may explain the high incidence of T12 vertebral fractures.
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Affiliation(s)
- Congyang Xue
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Guangda Sun
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Xiyu Liu
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Gansheng He
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Yubo Wei
- Department of Imaging, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, P.R.
China
- Department of Orthopaedics, Traditional Chinese Medicine Hospital of Ili Kazak Autonomous Prefecture, Yining,
China
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Yu W, Guan WM, Hayashi D, Lin Q, Du MM, Xia WB, Wang YXJ, Guermazi A. Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique. Osteoporos Int 2024; 35:831-839. [PMID: 38296865 DOI: 10.1007/s00198-024-07024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. PURPOSE The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. METHODS On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. RESULTS The height-to-width ratio of the half vertebrae varied 1.32-1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. CONCLUSION We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.
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Affiliation(s)
- W Yu
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
| | - W-M Guan
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - D Hayashi
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Q Lin
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Arion Cancer Center, Beijing, China
| | - M-M Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Zhejiang Province, Wenzhou, China
| | - W-B Xia
- Department of Endocrinology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Y-X J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - A Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
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Skjødt MK, Nicolaes J, Smith CD, Olsen KR, Libanati C, Cooper C, Abrahamsen B. Opportunistically identifiable vertebral fractures on routine radiological imaging predict mortality: observational cohort study. Osteoporos Int 2024; 35:691-703. [PMID: 38236389 PMCID: PMC10957599 DOI: 10.1007/s00198-024-07017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
In men and women with opportunistically identifiable vertebral fractures (VFs) on routine CT scans including the chest and/or abdomen, the risk of death is 51% higher than in those with no VF on the CT scan, and 325% higher than an age- and sex-matched general population cohort. PURPOSE There is little knowledge about the risk of death in patients with VFs present on routine radiological imaging. We evaluated the risk of death in men and women aged 50 years or older with opportunistically identifiable VFs on routine CT scans and not treated with osteoporosis medications. METHODS Thoracic and lumbar VFs were identified through a blinded, two-step approach on CT scans performed as part of normal clinical care in a Danish hospital in 2010 or later. Subjects with VF were matched on age and sex against those with no VF (1:2-ratio) and a general population cohort (1:3-ratio), respectively, and followed for up to 7 years through the national Danish registers. Subjects treated with an osteoporosis medication in the year prior to baseline were excluded. RESULTS Subjects with VF had a significantly higher risk of death during follow-up as compared to subjects with no VF on the CT scan (adjusted hazard ratio [HR] 1.51 [95% confidence interval 1.27-1.79; p < 0.001]) and even more so when compared to the general population cohort (HR 4.25 [3.53-5.12; p < 0.001]). In subjects with versus without VF on the CT scan, the risk was higher in those with moderate or severe VF, in those with no malignancy prior to baseline, and in those with a lower Charlson comorbidity index score. CONCLUSION Subjects with VF available for identification on routine CT scans face a substantially increased risk of death. Opportunistic identification and reporting of VF is important to identify these patients to allow intervention if indicated.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Joeri Nicolaes
- Department of Electrical Engineering (ESAT), Center for Processing Speech and Images, KU Leuven, Leuven, Belgium
- UCB Pharma, Brussels, Belgium
| | - Christopher Dyer Smith
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Kim Rose Olsen
- DaCHE, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Center, University of Southampton, Southampton General Hospital, Southampton, UK
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
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Li S, Yao Q, Li Y, Chen H, Qin J. To Evaluate the Value of Vertebral Body Cortical Thickness in Predicting Osteoporosis by Opportunistic CT. Acad Radiol 2024; 31:1491-1500. [PMID: 37783606 DOI: 10.1016/j.acra.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND In vertebrae, the amount of cortical bone has been estimated at 30-60%, but 45-75% of axial load on a vertebral body is borne by cortical bone (1). RATIONALE AND OBJECTIVES The purpose of this study is to investigate the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of vertebral body cortical thickness in predicting osteoporosis (OP) by analyzing the relationship between vertebral body cortical thickness and bone mineral density (BMD) in different age and gender groups. The optimal diagnostic cut-off value of vertebral body cortical thickness in predicting OP was analyzed. MATERIALS AND METHODS The data of 150 patients (50-89 years old) who underwent chest or abdominal Quantitative computed tomography (QCT) scan (obtained in one scan) in our hospital from July 2021 to July 2022 were retrospectively analyzed. The average volume bone mineral density (vBMD) of L1-L2 vertebral bodies was obtained and grouped according to BMD, age, and gender. According to BMD, the patients were divided into three groups: osteoporosis, osteopenia and normal. According to age, the patients were divided into three groups: 50-59 years, 60-69 years and ≥70 years. The axial images of T11, T12 and L1 were reconstructed with 1.25 mm slice thickness by AW4.7 workstation provided by General Electric Co (GE) Company. The images were imported into the computed tomography (CT) Spine Bone Quantification System software for spine analysis, and the vertebral body cortical thickness values were obtained. CT Spine Bone Quantification System is a software for quantitative analysis and separation of cortical bone and cancellous bone. RESULTS A total of 150 patients were enrolled in this study, including 49 patients in the osteoporosis group, 51 patients in the osteopenia group, and 50 patients in the normal group. The cortical thickness values of T11, T12 and L1 were positively correlated with BMD, and the correlation coefficient was 0.750 at T11. According to the receiver operating characteristic (ROC) curve analysis of T11, T12, L1 cortical thickness value and BMD, OP was diagnosed when T11 < 2.75 mm, T12 < 3.06 mm, and L1 < 2.67 mm. The sensitivity was 83.67%, 87.76%, 75.51%, respectively. The specificity was 79.21%, 71.29% and 90.10%, respectively, and the difference was statistically significant. CONCLUSION Vertebral body cortical thickness is correlated with BMD and age. According to the cut-off value of different vertebral bodies, OP can be predicted when T11 < 2.75 mm or T12 < 3.06 mm or L1 < 2.67 mm.
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Affiliation(s)
- Shanshan Li
- Department of Radiology, Shandong First Medical University, Tai'an, Shandong, China
| | - Qianqian Yao
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Tai'an 271000, Shandong, China
| | - Yang Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Tai'an 271000, Shandong, China
| | - Huafang Chen
- Department of Radiology, Shandong First Medical University, Tai'an, Shandong, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Tai'an 271000, Shandong, China.
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Huang S, Wu L, Lin S, Cai S, Zhou J. Analysis of factors related to osteoporotic vertebral fracture in prostate cancer patients. Discov Oncol 2024; 15:34. [PMID: 38347321 PMCID: PMC10861407 DOI: 10.1007/s12672-024-00886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE This study was aimed at exploring the osteoporotic vertebral fracture rate and the related causal factors in prostate cancer patients before and after treatment. METHODS One hundred prostate cancer patients were recruited in this study. One hundred men without prostate cancer history were selected as the control group. The study was approved by the Medical Ethics Committee under Ethics number B2021-373R and the requirement for the informed consent was waived. The T4-L1 vertebral body of the case group and the control group before and after treatment was evaluated according to Genant's semi-quantitative method. The difference in vertebral body fracture rate between the case group and the control group and the changes in vertebral body fracture rate before and after treatment among the case group were compared. They were grouped according to age, body mass index (BMI), prostate-specific antigen (PSA) levels, Gleason grade, and androgen deprivation therapy (ADT). Univariate and multivariate logistic regression models were used to determine the factors significantly associated with vertebral fracture rate in prostate cancer patients. RESULTS The prevalence of vertebral fracture was 16% and 31% in prostate cancer patients before and after treatment, respectively, and 29% in the control group. The vertebral fracture rate of the patients before treatment significantly differed that of the control group and the patients after treatment. Univariate analysis showed that age, PSA levels, and treatment parameters were the significant influencing factors of vertebral fracture rates. Multivariate logistic regression analysis showed that age was the main influencing factor of vertebral fracture rates. CONCLUSION Osteoporotic vertebral fractures in patients with prostate cancer was associated with many factors. And the incidence of vertebral fracture in prostate cancer patients after ADT was significantly higher than that before treatment.
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Affiliation(s)
- Shunfa Huang
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No.668 Jinhu Road, Huli District, Xiamen, 361015, China
| | - Lilan Wu
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No.668 Jinhu Road, Huli District, Xiamen, 361015, China
| | - Shuting Lin
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, No.34 Zhongshan North Road, Licheng District, Quanzhou, 362000, China
| | - Siqing Cai
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, No.34 Zhongshan North Road, Licheng District, Quanzhou, 362000, China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital (Xiamen), Fudan University, No.668 Jinhu Road, Huli District, Xiamen, 361015, China.
- Xiamen Municipal Clinical Research Center for Medical Imaging, No.668 Jinhu Road, Huli District, Xiamen, 361015, China.
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11
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Khalid TY, Peters TJ, Pocock LV, Drew S, Hardcastle SA, Paskins Z, Davis S, Kariki EP, Clark EM. An online clinical decision tool to screen for vertebral fragility fractures (Vfrac) in older women presenting with back pain in general practice: protocol for a feasibility study in preparation for a future cluster randomised controlled trial. Arch Osteoporos 2024; 19:12. [PMID: 38321322 PMCID: PMC10847189 DOI: 10.1007/s11657-023-01364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
This feasibility study for a future definitive randomized trial assesses the use and acceptability of a new clinical decision tool to identify risk of a vertebral fracture and those who should be referred for spinal radiography in women aged 65 or over presenting to primary care with back pain. PURPOSE Approximately 12% of older adults have vertebral fragility fractures, but currently fewer than one-third are diagnosed, potentially limiting access to bone protection treatment. Vfrac is a vertebral fracture screening tool which classifies individuals into high or low risk of having a vertebral fracture, allowing targeting of spinal radiographs to high-risk individuals. The objective of this study was to investigate the feasibility of conducting a cluster randomized controlled trial to evaluate the use of an online version of Vfrac in primary care. METHODS The study will run in six general practices, with three given the Vfrac tool for use on older women (> 65 years) consulting with back pain and three using standard clinical processes for managing such back pain. Anonymised data covering a 12-month period will be collected from all sites on consultations by older women with back pain. Focus groups will be undertaken with healthcare professionals and patients on whom the tool was used to understand the acceptability of Vfrac and identify factors that impact its use. These patients will be sent a paper version of the Vfrac questionnaire to self-complete at home. Outputs of the self-completion Vfrac (high versus low risk) will be compared with the face-to-face Vfrac (high versus low risk), and agreement assessed using Cohen's kappa. RESULTS This study will evaluate the use and acceptability of Vfrac within primary care and determine if data on resource use can be collected accurately and comprehensively. CONCLUSIONS This article describes the protocol of the Vfrac feasibility study. TRIAL REGISTRATION ISRCTN18000119 (registered 01/03/2022) and ISRCTN12150779 (registered 10/01/2022).
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Affiliation(s)
- Tanzeela Y Khalid
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK.
| | - Tim J Peters
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Lucy V Pocock
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
| | - Sarah A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
- Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eleni P Kariki
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Emma M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Learning and Research Building, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
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12
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Sardella C, Urbani C, Marconcini G, Cappellani D, Manetti L, De Liperi A, Romei C, Morganti R, Marcocci C, Bogazzi F. Conventional X-rays in the diagnosis and follow-up of vertebral fractures in patients with acromegaly: a real-life study. J Endocrinol Invest 2024; 47:325-334. [PMID: 37668886 DOI: 10.1007/s40618-023-02148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To explore the role of conventional X-ray imaging in detecting vertebral fractures (VFs) in patients with acromegaly, both at diagnosis of disease and at the last clinical visit. The risk factors for VFs were also evaluated. DESIGN AND METHODS A retrospective cohort study was conducted on 60 consecutive patients with acromegaly, in a tertiary referral centre. Thoracolumbar spine radiography (X-spine) was performed at the last clinical visit during the follow-up in order to detect VFs. Routine chest radiograph, performed as a part of the general evaluation at diagnosis of acromegaly, were retrospectively analysed to screen for baseline VFs. RESULTS At diagnosis of acromegaly, chest X-ray revealed that 10 (17%) patients had VFs. Of the 50 patients without VFs at diagnosis of acromegaly, 33 (66%) remained unfractured at the last clinical visit (median [IQR] time, 144 [96-192] months after the diagnosis of acromegaly), whereas 17 (34%) had VFs. Overall, 22 patients (37%) had novel VFs detected on X-spine including five patients with previous VFs. Risk factor for incident VFs was the presence of hypogonadism at diagnosis of acromegaly (p = 0.016). CONCLUSIONS In acromegaly patients, conventional X-rays can detect vertebral fractures early at diagnosis of acromegaly. They can also reveal incident VFs, which may occur several years later even in patients without VFs at diagnosis, above all in relation to hypogonadism.
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Affiliation(s)
- C Sardella
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy.
| | - C Urbani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - G Marconcini
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - D Cappellani
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - L Manetti
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - A De Liperi
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124, Pisa, Italy
| | - C Romei
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124, Pisa, Italy
| | - R Morganti
- Section of Statistics, Pisa University Hospital, 56126, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
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13
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Ma B, Smith A. Outpatient minimally invasive spine surgeries during the COVID-19 pandemic - A retrospective analysis of 164 consecutive cases. World Neurosurg X 2023; 20:100229. [PMID: 37456692 PMCID: PMC10344935 DOI: 10.1016/j.wnsx.2023.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/10/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To share our surgical experiences of minimally invasive cervical and lumbar procedures for patients who suffered from non-fatal motor vehicle accidents (MVAs) in the ambulatory surgery centers (ASCs) during the coronavirus disease 2019 (COVID-19) pandemic. Methods Anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), minimally invasive laminotomy and discectomy (MILD), percutaneous endoscopic laser-assisted discectomy (PELD) and percutaneous kyphoplasty (PK) were performed on carefully selected patients. Results From January 2020 to December 2021, our group performed 164 cases on 153 patients involving 249 intervertebral disc (IVD) levels. Of these, 116 cases (70.73%) on 114 patients (74.51%) were cervical, 48 cases (29.27%) were lumbar (including 8 PK cases). Eight patients had both cervical and lumbar procedures in a single anesthetic session (SAS) and were discharged on the same day. One hundred and six ACDF cases (92.17%) were at the C4-C5 and C5-C6 levels, which comprised of 146 (76.04%) IVDs. Of the 40 non-PK lumbar cases, 38 (95.0%) were at L4 to S1 lumbar levels. Six of these cases (15.0%) involved 2 lumbar levels. In contrast, 6 out of 8 kyphoplasties (75.0%) involved lower thoracic/higher lumbar vertebral columns (T11 to L2) and 2 were at the lower lumbar L4 level. Conclusions We successfully and safely performed various cervical and lumbar spine surgeries in the ASCs amid COVID-19 pandemic and all patients achieved the same-day discharge (SDD). In the non-fatal MVAs, mid-lower cervical (C4 to C6) and lower lumbar (L4 to S1) IVDs were the most affected levels.
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14
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Hueg TK, Hickey M, Beck AL, Wilson LF, Uldbjerg CS, Priskorn L, Abildgaard J, Lim Y, Bräuner EV. Risk of Fracture After Bilateral Oophorectomy. JBMR Plus 2023; 7:e10750. [PMID: 37457875 PMCID: PMC10339092 DOI: 10.1002/jbm4.10750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 07/18/2023] Open
Abstract
Fragility fractures, resulting from low-energy trauma, occur in approximately 1 in 10 Danish women aged 50 years or older. Bilateral oophorectomy (surgical removal of both ovaries) may increase the risk of fragility fractures due to loss of ovarian sex steroids, particularly estrogen. We investigated the association between bilateral oophorectomy and risk of fragility fracture and whether this was conditional on age at time of bilateral oophorectomy, hormone therapy (HT) use, hysterectomy, physical activity level, body mass index (BMI), or smoking. We performed a cohort study of 25,853 female nurses (≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from age 50 years or entry into the cohort, whichever came last, until date of first fragility fracture, death, emigration, or end of follow-up on December 31, 2018, whichever came first. Cox regression models with age as the underlying time scale were used to estimate the association between time-varying bilateral oophorectomy (all ages, <51/≥51 years) and incident fragility fracture (any and site-specific [forearm, hip, spine, and other]). Exposure and outcome were ascertained from nationwide patient registries. During 491,626 person-years of follow-up, 6600 nurses (25.5%) with incident fragility fractures were identified, and 1938 (7.5%) nurses had a bilateral oophorectomy. The frequency of fragility fractures was 24.1% in nurses who were <51 years at time of bilateral oophorectomy and 18.1% in nurses who were ≥51 years. No statistically significant associations were observed between bilateral oophorectomy at any age and fragility fractures at any site. Neither HT use, hysterectomy, physical activity level, BMI, nor smoking altered the results. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Trine K Hueg
- Department of Growth and ReproductionCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Martha Hickey
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneAustralia
| | - Astrid L Beck
- Department of Growth and ReproductionCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Louise F Wilson
- NHMRC Centre for Research Excellence on Women and Non‐communicable Diseases (CREWaND), School of Public HealthThe University of QueenslandHerstonAustralia
| | - Cecilie S Uldbjerg
- Department of Growth and ReproductionCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Lærke Priskorn
- Department of Growth and ReproductionCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Julie Abildgaard
- Centre for Physical Activity ResearchRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Youn‐Hee Lim
- Section of Environmental Health, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
- Seoul National UniversityMedical Research CenterSeoulRepublic of Korea
| | - Elvira V Bräuner
- Department of Growth and ReproductionCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
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15
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Tai TW, Tsai YL, Shih CA, Li CC, Chang YF, Huang CF, Cheng TT, Hwang JS, Lu TH, Wu CH. Refracture risk and all-cause mortality after vertebral fragility fractures: Anti-osteoporotic medications matter. J Formos Med Assoc 2023; 122 Suppl 1:S65-S73. [PMID: 37120337 DOI: 10.1016/j.jfma.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures may predict the future occurrence of fractures and increase mortality. Treating underlying osteoporosis may prevent second fractures. However, whether anti-osteoporotic treatment can reduce the mortality rate is not clear. The aim of this population study was to identify the degree of decreased mortality following the use of anti-osteoporotic medication after vertebral fractures. METHODS We identified patients who had newly diagnosed osteoporosis and vertebral fractures from 2009 to 2019 using the Taiwan National Health Insurance Research Database (NHIRD). We used national death registration data to determine the overall mortality rate. RESULTS There were 59,926 patients with osteoporotic vertebral fractures included in this study. After excluding patients with short-term mortality, patients who had previously received anti-osteoporotic medications had a lower refracture rate as well as a lower mortality risk (hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.81-0.88). Patients receiving treatment for more than 3 years had a much lower mortality risk (HR: 0.53, 95% CI: 0.50-0.57). Patients who used oral bisphosphonates (alendronate and risedronate, HR: 0.95, 95% CI: 0.90-1.00), intravenous zoledronic acid (HR: 0.83, 95% CI: 0.74-0.93), and subcutaneous denosumab injections (HR: 0.71, 95% CI: 0.65-0.77) had lower mortality rates than patients without further treatment after vertebral fractures. CONCLUSION In addition to fracture prevention, anti-osteoporotic treatments for patients with vertebral fractures were associated with a reduction in mortality. A longer duration of treatment and the use of long-acting drugs was also associated with lower mortality.
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Affiliation(s)
- Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Lun Tsai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Feng Huang
- Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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16
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Izquierdo-Avino R, Cebollada-Gadea L, Jordan-Jarque M, Bordonaba-Bosque D, López-Cabanas JA. Risk of osteoporotic fracture and refracture: the importance of index fracture site. Arch Osteoporos 2023; 18:27. [PMID: 36705860 DOI: 10.1007/s11657-023-01213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023]
Abstract
The current study shows that patients aged 50 or more who have sustained an osteoporotic fracture have a significant risk of suffering a new fracture. Refracture risk is also increased when anatomic site of both index and subsequent fracture are the same. PURPOSE The purpose of this study is to describe the profile of a patient sustaining a fragility fracture, the influence of the initial or index fracture on subsequent fracture risk and the role that anatomic site of index and subsequent fracture play on fracture risk. METHODS In this retrospective observational cohort study, individuals aged ≥ 50 years who sustained at least one clinical fragility fracture were identified from the public health service register between January 1, 2014, and December 31, 2015. Two separate analysis cohorts were identified. Group 1 (index FF) included patients that sustained at least one clinical fragility fracture during the study period. Group 2 (subsequent FF) included those patients from group 1 who sustained at least one clinical subsequent fracture during the following 2 years after index fracture. RESULTS A total of 11,986 fractures constituted group 1 (index FF), and 792 constituted group 2 (subsequent FF). The incidence of subsequent fractures was 6.61%, with a major percentage of them (36.99%) identified within the first 6 months following index FF. Hip was the most frequent site for index (30.09%) and subsequent fracture (34.85%). We found an increased risk mainly when anatomic site of index and subsequent FF are the same. CONCLUSIONS Sustaining a subsequent fracture after an index fracture is a common event in the population over age 50, more commonly occurring within 6 months of index fracture. Analysis of fracture site correlation shows that refracture risk is increased mainly when index and subsequent fracture site are the same.
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Affiliation(s)
- R Izquierdo-Avino
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain.
| | - L Cebollada-Gadea
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - M Jordan-Jarque
- Fracture Liaison Service Unit, Department of Trauma and Orthopaedic Surgery, Hospital Provincial Nuestra Señora de Gracia, Zaragoza, Spain
| | - D Bordonaba-Bosque
- Statistical and Methodological Support (SAME), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - J A López-Cabanas
- Statistical and Methodological Support (SAME), Aragon Health Sciences Institute (IACS), Zaragoza, Spain
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17
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van Atteveld JE, de Winter DTC, Pluimakers VG, Fiocco M, Nievelstein RAJ, Hobbelink MGG, de Vries ACH, Loonen JJ, van Dulmen-den Broeder E, van der Pal HJ, Pluijm SMF, Kremer LCM, Ronckers CM, van der Heiden-van der Loo M, Versluijs AB, Louwerens M, Bresters D, van Santen HM, Olsson DS, Hoefer I, van den Berg SAA, den Hartogh J, Tissing WJE, Neggers SJCMM, van den Heuvel-Eibrink MM. Risk and determinants of low and very low bone mineral density and fractures in a national cohort of Dutch adult childhood cancer survivors (DCCSS-LATER): a cross-sectional study. Lancet Diabetes Endocrinol 2023; 11:21-32. [PMID: 36513116 DOI: 10.1016/s2213-8587(22)00286-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Childhood cancer survivors are at risk of developing skeletal comorbidities later in life. We aimed to assess risk factors for low and very low bone mineral density (BMD), and the risk of and risk factors for any fractures and vertebral fractures in a national cohort of Dutch adult childhood cancer survivors. METHODS In this cross-sectional study, we used data from the DCCSS LATER cohort, which comprised individuals who were alive for at least 5 years after diagnosis of childhood cancer (ie, histologically confirmed malignancies or Langerhans cell histiocytosis), were diagnosed before the age of 19 years, and who had been treated at one of seven Dutch paediatric oncology centres between 1963 and 2002 (hereafter referred to as survivors). For this study, we invited survivors aged 18-45 years, who were alive as of Oct 10, 2016, living in the Netherlands, and who were deemed eligible by their treating physician to participate. We assessed BMD using dual-energy x-ray absorptiometry (DXA). Self-reported fractures that occurred at least 5 years after cancer diagnosis were assessed using available medical history and compared with population-level data from the Swedish national registry. We assessed vertebral fractures in a subset of participants using a vertebral fracture assessment. We assessed associations between the occurrence of low (Z-score of ≤-1) or very low (Z-score of ≤-2) BMD, fractures, and vertebral fractures and demographic, treatment-related, endocrine, and lifestyle-related factors using logistic regression analysis. FINDINGS Between April 29, 2016, and Jan 22, 2020, 3996 (64·8%) of 6165 individuals from the DCCSS LATER cohort were invited to participate, of whom 2003 (50·1%) were enrolled (mean age at participation was 33·1 years [SD 7·2], 966 [48·2%] were female, and 1037 [51·8%] were male [data on ethnicity and race were not available due to national policies]). 1548 (77·3%) had evaluable DXA scans for assessment of BMD, 1892 (94·5%) provided medical history of fractures, and 249 (12·4%) were assessed for vertebral fractures. 559 (36·1%) of 1548 had low BMD at any site, and 149 (9·6%) had very low BMD at any site. The standardised incidence ratio of any first fracture was 3·53 (95% CI 3·06-4·06) for male participants and 5·35 (4·46-6·52) for female participants. 33 (13·3%) of 249 participants had vertebral fractures. Male sex, underweight, high carboplatin dose, any dose of cranial radiotherapy, hypogonadism, hyperthyroidism, low physical activity, and severe vitamin D deficiency were associated with low BMD at any site and male sex, underweight, cranial radiotherapy, growth hormone deficiency, and severe vitamin D deficiency were associated with very low BMD at any site. Additionally, male sex, former and current smoking, and very low lumbar spine BMD were associated with any fractures, whereas older age at follow-up, previous treatment with platinum compounds, growth hormone deficiency, and low physical activity were specifically associated with vertebral fractures. INTERPRETATION Survivors of childhood cancer are at increased risk of any first fracture. Very low lumbar spine BMD was associated with fractures, highlighting the importance of active BMD surveillance in high-risk survivors (ie, those treated with cranial, craniospinal, or total body irradiation). Moreover, our results indicate that intensive surveillance and timely interventions for endocrine disorders and vitamin deficiencies might improve bone health in childhood cancer survivors, but this needs to be assessed in future studies. FUNDING Children Cancer-free Foundation (KiKa), KiKaRoW, and ODAS foundation.
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Affiliation(s)
| | | | | | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Medical Statistics Section, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, Netherlands; Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Rutger A J Nievelstein
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Imo Hoefer
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Internal Medicine, section Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands; Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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18
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Wang M, Chen X, Cui W, Wang X, Hu N, Tang H, Zhang C, Shen J, Xie C, Chen X. A computed tomography-based radiomics nomogram for predicting osteoporotic vertebral fractures: A longitudinal study. J Clin Endocrinol Metab 2022; 108:e283-e294. [PMID: 36494103 DOI: 10.1210/clinem/dgac722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/09/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
CONTEXT Fractures are serious consequence of osteoporosis in old adults. However, few longitudinal studies showed the role of computed tomography (CT)-based radiomics in predicting osteoporotic fractures. OBJECTIVE We evaluated the performance of CT radiomics-based model for osteoporotic vertebral fractures (OVF) in a longitudinal study. METHODS 7906 subjects without OVF who were aged over 50 years, and underwent CT scans between 2016 and 2019 were enrolled and followed up until 2021. Seventy-two cases of new OVF were identified. One hundred and forty-four people without OVF during follow-up were selected as control. Radiomics features were extracted from baseline CT images. CT values of trabecular bone, and area and density of erector spinae were determined. Cox regression analysis was used to identify the independent associated factors. The predictive performance of the nomogram was assessed using the receiver operating characteristic (ROC) curve, calibration curve and decision curve. RESULTS CT value of vertebra (adjusted hazard ratio (aHR) = 2.04, 95% confidence interval (CI): 1.07, 3.89), radiomics score (aHR = 6.56, 95%CI:3.47, 12.38) and area of erector spinae (aHR = 1.68, 95%CI: 1.02, 2.78) were independently associated with OVF. Radscore was associated with severe OVF (aHR = 6.00, 95% CI:2.78-12.93). The nomogram showed good discrimination with a C-index of 0.82 (95%CI: 0.77, 0.87). The area under the curve of nomogram and radscore were both higher than osteoporosis + muscle area for 3-year and 4-year risk of fractures (p < 0.05). Decision curve also demonstrated that the radiomics nomogram was useful. CONCLUSIONS Bone radiomics is associated with OVF and the nomogram based on radiomics signature and muscle provides a tool for the prediction of OVF.
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Affiliation(s)
- Miaomiao Wang
- Department of Radiology, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang road, Suzhou 215008, China
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Xin Chen
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai 200233, China
| | - Wenjing Cui
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Xinru Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Nandong Hu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Hongye Tang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Chao Zhang
- Department of Orthopaedics, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Jirong Shen
- Department of Orthopaedics, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, Nanjing 210029, China
| | - Chao Xie
- Department of Orthopaedics, University of Rochester School of Medicine, NY 14642, USA
| | - Xiao Chen
- Department of Radiology, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang road, Suzhou 215008, China
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Na D, Cong M, Zhang-Xin W, Rong C, Qin-Yi W, Yang-Na O, Zhi-Feng S. Underdiagnosis and underreporting of vertebral fractures on chest radiographs in men aged over 50 years or postmenopausal women with and without type 2 diabetes mellitus: a retrospective cohort study. BMC Med Imaging 2022; 22:81. [PMID: 35501729 PMCID: PMC9063367 DOI: 10.1186/s12880-022-00811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Osteoporotic vertebral fractures are often clinically silent and unrecognized. The present study aimed to determine whether routine chest radiographs could be a potential screening tool for identifying missed vertebral fractures in men aged over 50 years or postmenopausal women, especially those with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of undetected vertebral fractures in elderly Chinese patients with and without T2DM. Methods Clinical data and chest radiographs of 567 individuals with T2DM (T2DM group) and 583 without diabetes (nondiabetic group) at a tertiary hospital in central south China were extracted from the records. Vertebral fractures were specifically looked for on chest radiographs and classified using the Genant semi-quantitative scale. Prevalence was compared between the two groups. Results Mean age and sex composition were comparable between the two groups. Mean weight and body mass index were significantly lower in the T2DM group. In both groups, fractures mostly involved the T11–12 and L1 vertebrae. Moderate/severe fractures were identified in 33.3% individuals in the T2DM group (31.4% men and 36.0% women) versus 23.2% individuals (20.9% men and 25.5% women) in the nondiabetic group. Conclusions Routine chest radiographs could be a useful screening tool for identifying asymptomatic vertebral fractures. Trial registration The study was designed as an observational retrospective study, therefore a trial registration was not necessary.
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Affiliation(s)
- Ding Na
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Ma Cong
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Wen Zhang-Xin
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Chen Rong
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Wang Qin-Yi
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Ou Yang-Na
- Hospital Infection Control Center, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Sheng Zhi-Feng
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
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20
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Jäckle K, Saul D, Oberthür S, Roch PJ, Sehmisch S, Lehmann W, Weiser L. Long-term Quality of Life after Fusion of the Ventral Thoracic and Lumbar Spine. J Neurol Surg A Cent Eur Neurosurg 2021; 83:153-160. [PMID: 34808677 DOI: 10.1055/s-0041-1736324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cage implantations and autologous pelvic bone grafts are common surgical procedures to fuse the spine in cases of spinal disorders such as traumatic fractures or degenerative diseases. These surgical methods are designed to stably readjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. Benefits of these surgical interventions have been evaluated, but the long-term well-being of patients after the respective treatments has not yet been examined. This study was designed to evaluate the clinical outcome for patients who received iliac crest or cage implantations. MATERIAL AND METHODS Forty-six patients with traumatic fractures after they obtained an anterior fusion in the thoracic or lumbar spine (12 cages; mean age: 54.08 years; 34 pelvic bone grafts; mean age: 42.18 years) were asked to participate in the survey using a precast questionnaire according the Visual Analog Scale (VAS) Spine Score. Twenty-nine of them provided the data requested. RESULTS Evaluation of the VAS scores of the patients, reporting at least 1 year after the surgery, revealed that cage implantations led to significantly better results with respect to all aspects of their daily life such as pain sensing, capability to undertake physical activities and exercise as compared with patients with autologous pelvic bone graft. Patients with autologous pelvic bone graft treatment reported a particularly poor overall satisfaction level concerning their long-term well-being. CONCLUSIONS Patients with cage implantation reported a higher degree of long-term well-being. The data provide evidence for a positive impact on the postsurgery quality of life after cage implantation.
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Affiliation(s)
- Katharina Jäckle
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Dominik Saul
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, United States
| | - Swantje Oberthür
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Paul Jonathan Roch
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Lukas Weiser
- Department of Trauma Surgery, Orthopaedic Surgery and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
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21
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Dussault PM, McCarthy D, Davis SA, Thakore-James M, Lazzari AA. High prevalence of vertebral fractures in seizure patients with normal bone density receiving chronic anti-epileptic drugs. Osteoporos Int 2021; 32:2051-2059. [PMID: 33822290 DOI: 10.1007/s00198-021-05926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
UNLABELLED People with epilepsy who take certain medications are at risk for developing osteoporosis and fractures of the vertebrae that commonly go undiagnosed. By using technology available in a bone density scan, we observed at least one fracture in many subjects with bone density in the normal and osteopenic range. PURPOSE/INTRODUCTION Chronic use of antiepileptic drugs (AEDs), both enzyme-inducing (phenytoin, phenobarbital, carbamazepine, and primidone) and non-enzyme-inducing (i.e., valproate), is recognized as a cause of secondary osteoporosis. Vertebral compression fractures (VF) are the most common type of osteoporotic fractures and may confer an increased risk of future hip, wrist, and vertebral fractures. Vertebral compression fractures in the general population are frequently asymptomatic, and under-diagnosed. The purpose of this study is to describe the prevalence of VF in a cohort of male veterans with epilepsy on chronic AEDs. METHODS The cohort for this study consisted of 146 male veterans who carried a diagnosis of epilepsy and were chronic users of AEDs known to cause osteoporosis (phenobarbital, phenytoin, carbamazepine, primidone, and valproate). Chronic AED use was defined as receiving an AED for at least 2 years. Subjects were previously seen in the osteoporosis clinic and had been evaluated by a dual-energy X-Ray absormetry (DXA) instrument including morphometric studies following a standard vertebral fracture assessment (VFA) protocol during the same DXA imaging acquisition session. RESULTS The mean age was 63 years. Low bone mineral density defined as osteoporosis or osteopenia was observed in 29% and 43% respectively. We observed at least one VF in 41 % of the subjects who had normal BMD, 54% in the osteopenic range, and 75% in the osteoporotic range. CONCLUSIONS By performing a VFA in addition to standard bone densitometric studies, we disclosed a large prevalence of compression fractures in individuals with epilepsy chronically treated with AEDs who had BMDs in the normal and osteopenic ranges. The addition of VFA or other imaging methods to evaluate VF should be included in the evaluation of bone health in individuals with epilepsy receiving AEDs since it may modify treatment recommendations to prevent future osteoporotic fractures.
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Affiliation(s)
- P M Dussault
- VA Boston Health Care System, Boston, MA, USA.
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA.
| | - D McCarthy
- VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Harvard University Medical School, Boston, MA, USA
- Neurology Services, VA Boston HCS, Epilepsy Center of Excellence, Boston, MA, USA
| | - S A Davis
- VA Boston Health Care System, Boston, MA, USA
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA
| | - M Thakore-James
- VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Neurology Services, VA Boston HCS, Epilepsy Center of Excellence, Boston, MA, USA
| | - A A Lazzari
- VA Boston Health Care System, Boston, MA, USA
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Harvard University Medical School, Boston, MA, USA
- Primary Care and Rheumatology Sections, VA Boston Health Care System, Boston, MA, USA
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López Zúñiga D, Láinez-Ramos-Bossini AJ, Ruiz Santiago F. Radiographic diagnosis of osteoporotic vertebral fractures. An updated review. Med Clin (Barc) 2021; 158:125-132. [PMID: 34392986 DOI: 10.1016/j.medcli.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
The radiological diagnosis of osteoporotic vertebral fractures (OVFs) is of major importance considering its therapeutic and prognostic implications. Both radiologists and clinicians have the opportunity to diagnose OVFs in daily clinical practice due to the widespread use of spine and chest radiography. However, several studies have reported an under-diagnosis of OVFs, particularly by a lack of consensus on the diagnostic criteria. Therefore, up-to-date knowledge of the most relevant approaches for the diagnosis of OVFs is necessary for many physicians. This article aims to review the most commonly used classification systems in the diagnosis of OVFs based on conventional radiography. We discuss their rationale, advantages and limitations, as well as their utility according to the context. This review will provide a concise yet useful understanding of the typology of OVFs, their clinical significance and prognosis. Finally, we include anatomical variations that can be confused with OVFs by non-experts.
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Affiliation(s)
- Daniel López Zúñiga
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Antonio Jesús Láinez-Ramos-Bossini
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain; Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain; Department of Radiology and Physical Medicine, University of Granada, Granada, Spain.
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23
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Jäckle K, Brix T, Oberthür S, Roch PJ, Sehmisch S, Lehmann W, Weiser L. Cage or Pelvic Graft-Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures. MEDICINA-LITHUANIA 2021; 57:medicina57080786. [PMID: 34440992 PMCID: PMC8398686 DOI: 10.3390/medicina57080786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: Stabilization of the spine by cage implantation or autologous pelvic bone graft are surgical methods for the treatment of traumatic spine fractures. These methods serve to stably re-adjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. They both involve ventral interventions using interbody fusion to replace the intervertebral disc space between the vertebral bodies either by cages or autologous pelvic bone grafts. We examined which of these methods serves the patients better in terms of bone fusion and the long-term clinical outcome. Materials and Methods: Forty-six patients with traumatic fractures (12 cages; mean age: 54.08/34 pelvic bone grafts; mean age: 42.18) who received an anterior fusion in the thoracic or lumbar spine were included in the study. Postoperative X-ray images were evaluated, and fusion of the stabilized segment was inspected by two experienced spine surgeons. The time to discharge from hospital and gender differences were evaluated. Results: There was a significant difference of the bone fusion rate of patients with autologous pelvic bone grafts in favor of cage implantation (p = 0.0216). Also, the stationary phase of patients who received cage implantations was clearly shorter (17.50 days vs. 23.85 days; p = 0.0089). In addition, we observed a significant gender difference with respect to the bony fusion rate in favor of females treated with cage implantations (p < 0.0001). Conclusions: Cage implantations after spinal fractures result in better bony fusion rates as compared to autologous pelvic bone grafts and a shorter stay of the patients in the hospital. Thus, we conclude that cage implantations rather than autologous pelvic bone grafts should be the preferred surgical treatment for stabilizing the spine after fracture.
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KUTSAL FY, ERGİN ERGANİ GO. Vertebral compression fractures: Still an unpredictable aspect of osteoporosis. Turk J Med Sci 2021; 51:393-399. [PMID: 32967415 PMCID: PMC8203169 DOI: 10.3906/sag-2005-315] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
Vertebral compression fracture is a hallmark of osteoporosis (OP) and by far the most prevalent fragility fracture. It is well proven that patients who develop a vertebral compression fracture are at substantial risk for additional fractures. Diagnosis is based on adequate clinical evaluation, imaging, and laboratory tests. The imaging of OP and fragility fractures includes conventional radiology to evaluate spinal fractures, bone mineral density (BMD) testing by dual energy x-ray densitometry, quantitative computerized tomography, magnetic resonance imaging, bone scintigraphy (if necessary), and ultrasound. Screening and treatment of individuals with high risk of osteoporotic fracture are cost-effective, but approximately two-thirds of the vertebral compression fractures (VCF) that occur each year are not accurately diagnosed and, therefore, not treated. Evaluation of VCFs, even though they may be asymptomatic, seems essential to health-related and/or clinical research on OP.
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Affiliation(s)
- Fatma Yeşim KUTSAL
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Gizem Olgu ERGİN ERGANİ
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, AnkaraTurkey
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25
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Velioglu A, Kaya B, Aykent B, Ozkan B, Karapinar MS, Arikan H, Asicioglu E, Bugdaycı O, Yavuz DG, Tuglular S. Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study. PLoS One 2021; 16:e0251035. [PMID: 33930070 PMCID: PMC8087085 DOI: 10.1371/journal.pone.0251035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.
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Affiliation(s)
- Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Burcu Kaya
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Basar Aykent
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Bige Ozkan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Melis Sevil Karapinar
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Onur Bugdaycı
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Division of Endocrinology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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26
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Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep 2021; 11:5389. [PMID: 33686128 PMCID: PMC7940625 DOI: 10.1038/s41598-021-84724-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
Identifying the prevalence of degenerative spinal pathologies and relevant demographic risk factors is important for understanding spine injury risk, prevention, treatment, and outcome, and for distinguishing acute injuries from degenerative pathologies. Prevalence data in the literature are often based on small-scale studies focused on a single type of pathology. This study evaluates the prevalence of diagnosis of selected degenerative spinal pathology diagnoses using Medicare insurance claim data in the context of published smaller-scale studies. In addition, the data are used to evaluate whether the prevalence is affected by age, sex, diagnosed obesity, and the use of medical imaging. The Medicare Claims 5% Limited Data Set was queried to identify diagnoses of degenerative spinal pathologies. Unique patient diagnoses per year were further evaluated as a function of age, gender, and obesity diagnosis. Participants were also stratified by coding for radiological imaging accompanying each diagnosis. The overall prevalence of diagnosed spinal degenerative disease was 27.3% and increased with age. The prevalence of diagnosed disc disease was 2.7 times greater in those with radiology. The results demonstrate that degenerative findings in the spine are common, and, since asymptomatic individuals may not receive a diagnosis of degenerative conditions, this analysis likely underestimates the general prevalence of these conditions.
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Affiliation(s)
| | - Edmund C Lau
- Exponent, Inc., 3350 Peachtree Road NE, Suite 1125, Atlanta, GA, 30326, USA
| | - Ian C Campbell
- Exponent, Inc., 3350 Peachtree Road NE, Suite 1125, Atlanta, GA, 30326, USA.
| | - Amy Courtney
- Exponent, Inc., 3350 Peachtree Road NE, Suite 1125, Atlanta, GA, 30326, USA
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Davy SW, Bergin D. Opportunistic diagnosis of osteoporotic vertebral fractures on standard imaging performed for alternative indications. BJR Open 2021; 3:20210053. [PMID: 35707752 PMCID: PMC9185849 DOI: 10.1259/bjro.20210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/01/2022] Open
Abstract
Osteoporotic vertebral fractures (VFs) are the most common type of osteoporotic fracture. Patients with VF are at increased risk of hip fractures or additional VFs, both of which contribute to patient morbidity and mortality. Early diagnosis of VFs is essential so patients can be prescribed appropriate medical therapy. Most patients with clinical suspicion for VF have an X-ray of the spine. Many VFs are invisible on X-ray and require further imaging. CT can provide excellent bony detail but uses high doses of ionising radiation. MRI provides excellent soft tissue detail and can distinguish old from new fractures in addition to differentiating osteoporotic VFs from other causes of back pain. Bone scans have a limited role due to poor specificity. The literature suggests that radiologists frequently miss or do not report VFs when imaging is requested for an alternative clinical indication and when there is no clinical suspicion of VF. Common examples include failure to identify VFs on lateral chest X-rays, sagittal reformats of CT thorax and abdomen, lateral localizers on MRI and scout views on CT. Failure to diagnose a VF is a missed opportunity to improve management of osteoporosis and reduce risk of further fractures. This article discusses the role of radiographs, CT, MRI and bone scintigraphy in the assessment and recognition of osteoporotic fractures. This article focuses on opportunistic diagnosis of VFs on imaging studies that are performed for other clinical indications. It does not discuss use of dual energy X-ray absorptiometry which is a specific imaging modality for osteoporosis.
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Affiliation(s)
- Shane W. Davy
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Diane Bergin
- Department of Radiology, University Hospital Galway, Galway, Ireland
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Jones L, Singh S, Edwards C, Goyal N, Singh I. Prevalence of Vertebral Fractures in CTPA's in Adults Aged 75 and Older and Their Association with Subsequent Fractures and Mortality. Geriatrics (Basel) 2020; 5:geriatrics5030056. [PMID: 32967139 PMCID: PMC7555387 DOI: 10.3390/geriatrics5030056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/29/2023] Open
Abstract
Identifying vertebral fractures is prudent in the management of osteoporosis and the current literature suggests that less than one-third of incidental vertebral fractures are reported. The aim of this study is to determine the prevalence of reported and unreported vertebral fractures in computerized tomography pulmonary angiograms (CTPA) and their relevance to clinical outcomes. All acutely unwell patients aged 75 or older who underwent CTPAs were reviewed retrospectively. 179 CTPAs were reviewed to identify any unreported vertebral fractures. A total of 161 were included for further analysis. Of which, 14.3% (23/161) were reported to have a vertebral fracture, however, only 8.7% (14/161) of reports used the correct terminology of ‘fracture’. On subsequent review, an additional 19.3% (31/161) were noted to have vertebral fractures. Therefore, the overall prevalence of vertebral fractures was 33.5% (54/161). A total of 22.2% (12/54) of patients with a vertebral fracture on CTPA sustained a new fragility fracture during the follow-up period (4.5 years). In comparison, a significantly lower 10.3% (11/107) of patients without a vertebral fracture developed a subsequent fragility fracture during the same period (p = 0.04). Overall mortality during the follow-up period was significantly higher for patients with vertebral fractures (68.5%, 37/54) as compared to those without (45.8%, 49/107, p = 0.006). Vertebral fractures within the elderly population are underreported on CTPAs. The significance of detecting incidental vertebral fractures is clear given the increased rates of subsequent fractures and mortality. Radiologists and physicians alike must be made aware of the importance of identifying and treating incidental, vertebral fragility fractures.
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Affiliation(s)
- Llewelyn Jones
- Health Education and Improvement Wales (HEIW), Wales CF15 7QQ, UK;
| | - Sukhdev Singh
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport NP20 4SZ, UK; (S.S.); (N.G.)
| | - Chris Edwards
- Department of Dermatology, St Wollas Hospital, Aneurin Bevan University Health Board, Newport N20 2UB, UK;
| | - Nimit Goyal
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport NP20 4SZ, UK; (S.S.); (N.G.)
| | - Inder Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Ystrad Mynach CF82 7EP, UK
- Correspondence: ; Tel.: +44-144-380-2234; Fax: +44-144-380-2431
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29
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Alseddeeqi E, Bashir N, AlAli KF, Ahmed LA. Characteristics of patients with low-trauma vertebral fractures in the United Arab Emirates: a descriptive multi-center analysis. Endocr J 2020; 67:785-791. [PMID: 32238668 DOI: 10.1507/endocrj.ej20-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vertebral fracture is the most common type of osteoporotic fracture. However, the prevalence of osteoporosis and osteoporotic vertebral fractures were not explored previously in the United Arab Emirates (UAE). This study aims to describe for the first time the demographic and morphological characteristics of patients with fragility vertebral fractures in the UAE through a retrospective review of the medical records of patients with low-trauma vertebral fractures who visited two tertiary centers during 2011-2016. The sex, age at the time of fracture, nationality, body mass index (BMI), and anatomical fracture location were recorded for each patient. Overall, 143 subjects were diagnosed with low-trauma vertebral fractures in the Emirate of Abu Dhabi during 2011-2016. Of these, 98 were women (68.5%) and 45 were men (31.5%). The overall mean patient age at diagnosis was 62.5 years, and almost half were younger than 65 years. Approximately 60% of the patients were UAE nationals. Fifty-one patients (36.7%) were obese (mean BMI: 35.3 kg/m2), and women with vertebral fractures had a significantly higher mean BMI compared with men (p = 0.041). Nearly 40% of men had a normal BMI, compared with 20% of women. Most fractures were compression fractures (77.6%) in the thoracolumbar transition region. In conclusion, patients with fragility vertebral fractures were predominantly female and tended to be overweight or obese, although male patients tended to have a lower BMI than female patients.
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Affiliation(s)
- Eiman Alseddeeqi
- Division of Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nihal Bashir
- Division of Internal Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khaled F AlAli
- Division of Neurosurgery, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Anderson PA, Conley RB. Secondary fracture prevention: review of recent American Society for Bone and Mineral Research multidisciplinary stakeholder consensus recommendations. Spine J 2020; 20:1044-1047. [PMID: 32624148 DOI: 10.1016/j.spinee.2020.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Paul A Anderson
- Department of Orthopedic Surgery & Rehabilitation, University of Wisconsin, UWMF Centennial Bldg, 1685 Highland Ave, 6th floor Madison, WI 53705-2281, USA.
| | - Robert B Conley
- Center for Medical Technology Policy, 401 E Pratt St, Suite 631, Baltimore, MD, 21202, USA.
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31
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Blank RD. Practical management of fracture risk among peri- and postmenopausal women. Fertil Steril 2020; 112:782-790. [PMID: 31731932 DOI: 10.1016/j.fertnstert.2019.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
Fractures and their consequences are the clinically important manifestation of osteoporosis; preventing fractures is the primary goal of management. Effective management is achievable given present knowledge and tools but is seldom prescribed. This review will cover the individual and social burden of fracture, essential information about fracture risk and its estimation, an approach to patient care emphasizing specific information to elicit and therapeutic strategies to pursue, and existing gaps in knowledge and important questions for future research.
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Affiliation(s)
- Robert D Blank
- Medical College of Wisconsin, Wauwatosa, Wisconsin; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.
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Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Orthop Trauma 2020; 34:e125-e141. [PMID: 32195892 DOI: 10.1097/bot.0000000000001743] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).
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Wáng YXJ, Du MM, Che-Nordin N, Ye PP, Qiu SW, Griffith JF, Yan ZH. Recognizing osteoporotic vertebral deformity on frontal view radiograph: a cohort analysis and a pictorial review. Arch Osteoporos 2020; 15:41. [PMID: 32144508 DOI: 10.1007/s11657-020-00716-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Opportunities exist to detect osteoporotic vertebral deformities (VDs) on frontal radiograph (FR) indicated for lung or abdominal diseases, while literature have been mostly based on lateral radiograph (LR). This study analyzed the detectability of moderate and severe grades VD on FR. METHODS There were 105 female cases (mean 72 years, range 55~93 year), who were referred for digital spine FR and LR with back and/or leg pain. The LR and FR were read, osteoporotic VDs with < 20%, 20-25%, 25-40%, and > 40% vertebral body height loss were recorded as minimal, mild, moderate, and severe grades, respectively. After a 10-month interval, only FRs were read again, and each vertebra was classified as (1) no notable VD, (2) with notable VD, and (3) ambiguous. The first reading was the reference, while the second reading was allowed to miss minimal/mild VCD and endplate/cortex fracture. RESULTS Counting by subjects, for 98 cases, the two reading sessions had agreement, including 43 "true negative" cases and 55 true positive cases. There were two false positive cases, and five ambiguous cases. In total, 1286 vertebra were assessed, FR reading had 1126 vertebrae "true negative," 130 vertebrae true positive, one vertebra false negative, 3 vertebrae false positive, and 26 ambiguous vertebrae (65.4% being true negative and 34.6% being true positive). Most of the disagreements were associated with kyphosis or poor X-ray projection. Nineteen illustrative cases are presented graphically. CONCLUSION Moderate and severe grades of VD are identifiable on FR as long as the involved vertebrae are clearly filmed.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | - Mei-Mei Du
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Pei-Pei Ye
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Shi-Wen Qiu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Zhi-Han Yan
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China.
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34
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Cai S, Yu H, Li Y, He X, Yan L, Huang X, Wang P. Bone mineral density measurement combined with vertebral fracture assessment increases diagnosis of osteoporosis in postmenopausal women. Skeletal Radiol 2020; 49:273-280. [PMID: 31352490 DOI: 10.1007/s00256-019-03280-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoporosis is diagnosed based on the results of BMD assessment and/or fragility fractures. Vertebral fracture is the most common fragility fracture. Many vertebral fractures are asymptomatic and are not clinically recognized. Early detection of vertebral fracture may increase diagnosis of osteoporosis. In this study, we performed BMD measurement combined with vertebral fracture assessment (VFA) by DXA for the postmenopausal women receiving the first bone densitometry and studied the impact of VFA on the diagnosis of osteoporosis. METHODS A total of 502 postmenopausal women were enrolled in our study. Patients' age was 66.7 ± 9.5 years. All patients had BMD assessment and VFA by dual-energy X-ray absorptiometry. Genant's semiquantitative assessment was used. The impact of VFA on the diagnosis of osteoporosis was studied. All parameters of groups were compared using the Chi-squared test. RESULTS There were 257 patients with T-score ≤-2.5, 202 patients with a T-score between -1 and - 2.5, and 43 patients with BMD within the normal range. There were 162 patients with 345 fractured vertebrae identified by VFA, among which 84% of patients were previously unknown. Osteoporosis or severe osteoporosis was presented in 51.2% patients diagnosed by BMD alone, in 55.2% patients diagnosed by BMD plus fracture history, and in 62.4% of patients diagnosed by BMD plus fracture history and VFA. Severe osteoporosis significantly increased by 17.2% in patients receiving VFA. CONCLUSIONS VFA combined with BMD can detect previously unknown vertebral fractures and increase clinical diagnosis of osteoporosis. It is plausible to speculate that this method should be considered in postmenopausal women for the first BMD assessment.
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Affiliation(s)
- Siqing Cai
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
| | - Haiming Yu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
| | - Yizhong Li
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China.
| | - Xiaobo He
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
| | - Lisheng Yan
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
| | - Xueqing Huang
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
| | - Peiwen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Zhongshan North road 34, Quanzhou, 362000, Fujian, China
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35
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Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, Clarke BL, Cody KM, Cooper C, Crandall CJ, Dirschl DR, Eagen TJ, Elderkin AL, Fujita M, Greenspan SL, Halbout P, Hochberg MC, Javaid M, Jeray KJ, Kearns AE, King T, Koinis TF, Koontz JS, Kužma M, Lindsey C, Lorentzon M, Lyritis GP, Michaud LB, Miciano A, Morin SN, Mujahid N, Napoli N, Olenginski TP, Puzas JE, Rizou S, Rosen CJ, Saag K, Thompson E, Tosi LL, Tracer H, Khosla S, Kiel DP. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Bone Miner Res 2020; 35:36-52. [PMID: 31538675 DOI: 10.1002/jbmr.3877] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022]
Abstract
Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | - Ivy M Alexander
- UConn School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Kelly C Amenta
- Department of Physician Assistant Studies, Mercyhurst University, Erie, PA, USA
| | - Robert D Blank
- Department of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | | | - Emily E Carmody
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Douglas R Dirschl
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Ann L Elderkin
- American Society for Bone and Mineral Research, Washington, DC, USA
| | - Masaki Fujita
- Science Department, International Osteoporosis Foundation, Nyon, Switzerland
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Marc C Hochberg
- Division of Rheumatology, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD, USA
| | - Muhammad Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, USA
| | - Kyle J Jeray
- Prisma Health - Upstate (formerly Greenville Health System), Greenville, SC, USA
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Toby King
- US Bone and Joint Initiative, Rosemont, IL, USA
| | | | - Jennifer Scott Koontz
- Orthopedics & Sports Medicine, Newton Medical Center, Newton, KS, USA.,Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, KS, USA
| | - Martin Kužma
- 5th Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia
| | - Carleen Lindsey
- Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC, Bristol, CT, USA
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.,Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Nadia Mujahid
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Nicola Napoli
- Department of Nutrition and Metabolic Disorders, Campus Bio-Medico University of Rome, Rome, Italy.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - J Edward Puzas
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Clifford J Rosen
- Tufts University School of Medicine, Boston, MA, USA.,Maine Medical Center Research Institute, Portland, ME, USA
| | - Kenneth Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Laura L Tosi
- Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
| | - Howard Tracer
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas P Kiel
- Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
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36
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Zhou Z, Sun Z, Wang Y, Zhu X, Qian Z. Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study. J Int Med Res 2019; 48:300060519894764. [PMID: 31885305 PMCID: PMC7783268 DOI: 10.1177/0300060519894764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the safety and efficacy of kyphoplasty in the treatment of occult
and non-occult osteoporotic vertebral compression fractures (OOVF). Material and Methods From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral
compression fractures (N-OOVF) were evaluated with the Visual Analog Scale
(VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively,
immediately postoperatively, and one year postoperatively. Operative time,
fluoroscopy time, and cement injection volume were recorded. Results Compared with the preoperative VAS and ODI scores, the scores of both groups
were significantly improved after surgery. Preoperative ODI and VAS scores
of the OOVF were lower than those of the N-OOVF. The operative time,
fluoroscopy time, and bone cement injection volume of the OOVF were
significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF
improved significantly after surgery. There were differences in cement
leakage and adjacent vertebral fractures between the two groups. Conclusion Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to
diagnose OOVF in a timely manner.
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Affiliation(s)
- Zhangzhe Zhou
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiyong Sun
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yimeng Wang
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoyu Zhu
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhonglai Qian
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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37
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Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China. J Orthop Translat 2019; 23:152-158. [PMID: 32913707 PMCID: PMC7452293 DOI: 10.1016/j.jot.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
Aim Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. Materials and methods This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. Results There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. Conclusion Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. The translational potential of this article The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed.
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