Effects of conservative treatment of 2-week rigorous bed rest on muscle disuse atrophy in osteoporotic vertebral fracture patients

Exploring factors affecting activities of daily living in patients with osteoporotic vertebral fractures managed conservatively: a post-hoc analysis of a prospective cohort study

STUDY DESIGN

A post-hoc analysis of a prospective cohort study.

PURPOSE

This study aimed to identify factors at the time of injury associated with declining activities of daily living (ADLs) in the chronic phase of osteoporotic vertebral fractures (OVFs) managed conservatively.

OVERVIEW OF LITERATURE

Although a conservative approach is the treatment of choice for OVFs, ADLs do not improve or eventually decrease in some cases. However, the risk factors for ADL decline after the occurrence of OVFs, particularly the difference between those with or without initial bed rest, are unknown.

METHODS

A total of 224 consecutive patients with OVFs aged ≥65 years who received treatment within 2 weeks after the occurrence of injury were enrolled. The patients were followed up for 6 months thereafter. The criteria for evaluating the degree of independence were applied to evaluate ADLs. Multivariable analysis with a logistic regression model was performed to evaluate the risk factors for ADL decline.

RESULTS

In total, 49/224 patients (21.9%) showed a decline in ADLs. Of these, 23/116 patients (19.8%) in the rest group and 26/108 patients (24.1%) in the no-rest group experienced a decline in ADLs. In the logistic regression analyses, a diffuse low signal on T2- weighted magnetic resonance imaging (MRI) (odds ratio, 5.78; 95% confidence interval, 2.09-16.0; p=0.0007) and vertebral instability (odds ratio, 3.89; 95% confidence interval, 1.32-11.4; p=0.0135) were identified as independent factors in the rest and no-rest groups, respectively.

CONCLUSIONS

In patients with acute OVFs, a diffuse low signal on T2-weighted MRI and severe vertebral instability were independently associated with ADL decline in patients treated with and without initial bed rest, respectively.

Equivalent values between anterior vertebral height, wedge ratio, and wedge angle for evaluating vertebral mobility and deformity in osteoporotic vertebral fractures: a conventional observational study

BACKGROUND

Vertebral mobility (V-mobility) has been used to diagnose fresh osteoporotic vertebral fractures (OVFs) and determine bone union by setting cutoff values for these purposes. V-mobility is the difference in vertebral height on dynamic radiographs taken in the sitting and lateral decubitus or supine positions. The dimensions for V-mobility were presented as anterior vertebral height (Ha; mm), wedge ratio (WR; %), and wedge angle (WA; °) in previous reports. This study was performed to obtain WR and WA values equivalent to V-mobility of 1.0 mm in Ha.

METHODS

Lateral radiographs of 284 OVFs (grade 1-3 deformed vertebrae) from T11 to L2 were obtained from 77 patients with OVF. V-mobility presented as Ha, posterior vertebral height, and WA was obtained by the difference in these dimensions on dynamic radiographs. The WR and WA values equivalent to 1.0 mm in Ha were obtained by dividing the V-mobility values for WR and WA by that for Ha.

RESULTS

The mean WR values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 3.2% ± 1.4%, 3.2% ± 0.9%, and 3.4% ± 1.0%, respectively, and the corresponding value for grade 1-3 vertebrae was 3.3% ± 1.0%. The mean WA values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 1.5° ± 0.8°, 1.5° ± 0.6°, and 1.5° ± 0.8°, respectively, and the corresponding value for grade 1-3 vertebrae was 1.5° ± 0.7°.

CONCLUSIONS

The WR and WA values equivalent to V-mobility of 1.0 mm in Ha were 3.3% and 1.5°, respectively, in grade 1-3 vertebrae. These findings may be useful to secure a reliable value of V-mobility of OVFs using simultaneous measurements in three dimensions (Ha, WR, and WA) in clinical practice and to establish cutoff values for V-mobility to determine bone union.

Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures: A Prospective Cohort Study

UPDATE

This article was updated on October 19, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1787, in the legend for Figure 2, the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (A/P) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." now reads "The vertebral collapse rate (in %) was defined as (1 - [A/P]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." On page 1788, in the section entitled "Data Collection," the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (anterior vertebral wall height/posterior vertebral wall height) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." now reads "The vertebral collapse rate (in %) was defined as (1 - [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." Finally, on page 1791, in Table IV, the footnote for the "Primary outcome" row that had read "N = 113 in the rest group and 99 in the no-rest group." now reads "N = 116 in the rest group and 108 in the no-rest group."