Assessment of the Necessity of Osteoporosis Treatment for Patients with Low Bone Density in Diffuse Idiopathic Skeletal Hyperostosis

Abstract

Introduction: Although patients with diffuse idiopathic skeletal hyperostosis (DISH) do not have low bone density, it is a risk factor for spine fractures associated with DISH. We investigated the characteristics and bone metabolism markers of patients with DISH having low bone density to assess whether osteoporosis medication is necessary to prevent fractures.Methods: A cross-sectional study was conducted between April 1, 2008, and March 31, 2019. The 86 patients included were divided into two groups according to their T-scores-one group had low bone density and DISH, and the other group did not. Group A (T-score! −1) and B (T-score>−1) data were adjusted for confounding factors and compared for differences in age, body weight, maximum number of vertebral bodies with bony bridges between adjacent vertebrae (max VB), and previous history (hypertension, malignant tumors, diabetes mellitus, cardiac diseases, chronic renal failure, and spinal fractures). In Group A, multiple linear regression was used to investigate relationships among max VB, femur bone mineral density (BMD), total type I procollagen N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5 b).Results: Group A had 36, and Group B had 50 male patients with DISH. Patients in Group B were heavier than those in Group A. The mean femur BMD in Group A was age-appropriate, and that in Group B was higher than the age-appropriate femur BMD. The mean values of P1NP and TRACP-5b were within the normal range. Max VB was positively correlated with total P1NP in Group A. Total P1NP was significantly and positively correlated with TRACP-5b.Conclusions: The DISH group with a T-score of ! −1 was age-appropriate. The group with a T-score of >−1 had higher BMD because of their higher body weight. The group with a T-score of ! −1 had good bone metabolism and did not require aggressive osteoporosis treatment.

Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion-

“…Therefore, the maxVB (2–8) can be associated with good bone healing in terms of bone density. In contrast, in patients without fracture, the maxVB, a measure of lever arm fracture extent, is positively correlated with N-propeptide of type I procollagen (P1NP), the osteogenic marker [ 21 , 43 ]. Inose et al developed the bone turnover ratio (BTR), which is a measure of bone remodelling for posterior lumbar intervertebral fusion because low P1NP and high tartrate-resistant acid phosphatase 5b (TRACP 5b) levels are risk factors for poor bone remodelling [ 44 ].…”

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures

“…Additionally, patients in the maxVB (4-8) group had a higher proximal femur bone density than those in the maxVB (9-18) group [10]. Therefore, the maxVB was measured using CT from the thoracic to lumbar spines and categorized into three groups: no bony bridging, maxVB (0); from 2 to 8, maxVB (2-8); and from 9 to 18, maxVB (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The American Spinal Injury Association (ASIA) impairment scale and AO neurological type (N0, neurology intact; N1, transient neurological deficit; N2, radicular symptoms; N3, incomplete spinal cord injury or any degree of cauda equina injury; and N4; complete spinal cord injury) were used to assess neurological symptoms [13,14].…”

“…The complex interplay between bone density and bridging makes it challenging to understand the fracture mechanics of DISH; lower bone density and longer lever arms increase the risk of fractures. Previously, we devised an index for the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB) to measure the lever arms [ 9 ]; it captures not only the length of the lever arm but also, to some extent, bone density and bone metabolism markers [ 10 , 11 ]. A definition by Resnick et al [ 12 ] of DISH as a bony bridge spanning four vertebrae is widely used.…”

Number of contiguous vertebral cross-links in the spine indicates bone formation: a cross- sectional study

“…Subsequently, we considered max VB and BMD. Regarding bone density in DISH, there have been reports of higher or unchanged bone density compared with controls [11][12][13][14][15][16]; however, bone density is higher for max VB from 4 to 8 and unchanged for max VB from 9 to 18 compared with the non-DISH group. Therefore, bone density results in cases of DISH will vary depending on the max VB [21].…”

“…Thus, DISH, which naturally progresses bone cross-linking with age, could be advantageous for bone healing after spinal fusion surgery. However, some previous reports have shown that BMD is unchanged or higher in patients with DISH than in controls, i.e., people without DISH [11][12][13][14][15][16]. With respect to BMM, some studies have reported higher intact parathyroid hormone levels but lower P1NP and serum sclerostin levels, while others have reported lower dickkof-1 levels, which suppress sclerostin; however, the results in none of these reports were conclusive [17][18][19].…”