Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study

Abstract

Purpose New vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs. Methods This study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA). Results A total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values. Conclusions In this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.

Prediction of new vertebral compression fracture within 3 years after percutaneous vertebroplasty for osteoporotic vertebral compression fracture: Establishment and validation of a nomogram prediction model

“…Recently, researchers developed predictive models for NVCF after OVCF [ 25 – 28 ]. A recent retrospective study by Bian et al found that 23.8% (69/292) of patients develop NVCF after PVP surgery, and they found four independent risk factors, including age, HU value, cement leakage, and thoracolumbar junction fracture, could predict NVCF [ 26 ]. Li et al found that 15.1% (58/385) of OVCF patients develop NVCF after PVP surgery, and, they found that higher BMI, lower BMD, multisegment vertebral fractures, no previous anti-osteoporosis treatment, and steroid use were more likely to result in NVCF after PVP surgery [ 27 ].…”

Risk factors of new vertebral compression fracture after percutaneous vertebroplasty or percutaneous kyphoplasty

“…Bian et al. ( 26 ) concluded that age, HU value, TL junction fracture, and cement leakage were correlated with new VCF after PVP in patients with OVCF. In this study, only a low HU value was the independent risk factor of new VCF after PVP or PKP by multivariate regression analysis.…”

“…Ning et al (25) reported that risk factors of new VCF after PKP for OVCF were gender, zoledronic acid, and previous fracture history rather than BMI, smoking, alcohol, hypertension, and diabetes. Bian et al (26) concluded that age, HU value, TL junction fracture, and cement leakage were correlated with new VCF after PVP in patients with OVCF. In this study, only a low HU value was the independent risk factor of new VCF after PVP or PKP by multivariate regression analysis.…”

Effect of osteosarcopenia on the development of a second compression fracture and mortality in elderly patients after vertebroplasty

“…The L3 vertebrae average Hounsfield Unit (HU) value was calculated as follows: the vertebral body was divided into 3 equal parts in the sagittal plane, and the largest elliptical region of interest (ROI) containing only bone trabeculae was drawn in the axial plane to obtain the average CT value, avoiding the cortical bone and posterior venous plexus 4 ( Figure 1 A).…”