Fatty infiltration of the multifidus muscle independently increases osteoporotic vertebral compression fracture risk

Abstract

Background Vertebral compression fractures decrease daily life activities and increase economic and social burdens. Aging decreases bone mineral density (BMD), which increases the incidence of osteoporotic vertebral compression fractures (OVCFs). However, factors other than BMD can affect OVCFs. Sarcopenia has been a noticeable factor in the aging health problem. Sarcopenia, which involves a decrease in the quality of the back muscles, influences OVCFs. Therefore, this study aimed to evaluate the influence of the quality of the multifidus muscle on OVCFs. Methods We retrospectively studied patients aged 60 years and older who underwent concomitant lumbar MRI and BMD in the university hospital database, with no history of structurally affecting the lumbar spine. We first divided the recruited people into a control group and a fracture group according to the presence or absence of OVCFs, and further divided the fracture group into an osteoporosis BMD group and an osteopenia BMD group based on the BMD T-score of -2.5. Using images of lumbar spine MRI, the cross-sectional area and percentage of muscle fiber (PMF) of the multifidus muscle were obtained. Results We included 120 patients who had visited the university hospital, with 45 participants in the control group and 75 in the fracture group (osteopenia BMD: 41, osteoporosis BMD: 34). Age, BMD, and the psoas index significantly differed between the control and fracture groups. The mean cross-sectional area (CSA) of multifidus muscles measured at L4-5 and L5-S1, respectively, did not differ among the control, P-BMD, and O-BMD groups. On the other hand, the PMF measured at L4-5 and L5-S1 showed a significant difference among the three groups, and the value of the fracture group was lower than that of the control group. Logistic regression analysis showed that the PMF value, not the CSA, of the multifidus muscle at L4-5 and L5-S1 affected the risk of OVCFs, with and without adjusting for other significant factors. Conclusions High percentage of fatty infiltration of the multifidus muscle increases the spinal fracture risk. Therefore, preserving the quality of the spinal muscle and bone density is essential for preventing OVCFs.

Paraspinal muscle parameters’ predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation

“…Our analysis revealed that multifidus SMI is an independent protective factor against NVCF after PVP/PKP. Consistent with Lee et al ( 31 ), who found no difference in average CSA of multifidus between OVCF with osteoporosis, OVCF with bone loss, and the non-OVCF groups. However, multifidus FCSA in the OVCF group was significantly lower than the non-OVCF group.…”

Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies

“…Lee et al ( 64 ) showed a significant association between multifidus muscle percentage of muscle fibre and OVF al L4/L5–L5/S1, but not with multifidus muscle CSA which appeared to be higher in the fracture group when compared to the control group. According to this study group the fatty infiltration of the paraspinal muscle, rather than the muscle CSA, significantly affect the risk of OVF.…”

Fatty Infiltration of Multifidus Muscles: An Easily Overlooked Risk Factor for the Severity of Osteoporotic Vertebral Fractures

“…Similarly, it is noteworthy that their study solely encompassed female participants, a factor that might have had a bearing on the results. 27 Jeon et al examined 55 consecutive patients with OVF who were treated conservatively in a single spine center. Their study ascertained that fatty degeneration of the paraspinal muscles was a predictor of progressive vertebral collapse.…”