Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass

Wagner, Daniel; Hofmann, Alexander; Kamer, Lukas; Sawaguchi, Takahiro; Richards, R. Geoff; Noser, Hansrudi; Gruszka, Dominik; Rommens, Pol Maria

doi:10.1007/s00402-018-2938-5

Cited by 41 publications

(33 citation statements)

References 43 publications

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“…Recent imaging studies have employed 3D modelling of an osseous template and have quantified the distribution of bone mass within the posterior pelvic ring, albeit in a small patient cohort 4,5 . There were clear differences in bone density between the sacral alae and the vertebral bodies of the os sacrum.…”

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confidence: 99%

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Thiesen

Ntalos

Berger-Groch

et al. 2020

Sci Rep

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information compared to the traditional greyscale CT-slides. We hypothesized that there would be a constant lower bone density in the posterior pelvic ring screw corridors in individuals with decreased bone stock in the 5th lumbar vertebra. Methods Study population. Five hundred and thirty-seven (n = 537) raw CT datasets were analyzed. These had all originally been obtained for medical reasons: 20% patients after trauma, 70% for CT angiography and 10% for non-defined indications (median pixel spacing: 0.78 mm, median slice spacing: 1.00 mm). The data was collected retrospectively by Stryker Trauma GmbH between 2008 and 2017 with the prior written consent of the patient. Personal data such as name, date of birth or date of CT associated with the datasets were removed and not provided to the company. CT scans that included the skull were also excluded. The available demographic data generally included age, BMI and gender. In some cases, BMI, age or gender were not provided due to individual hospital data protection policies. Fractured or severely malformed pelvises (tumorous, post-osteomyelitis, post-traumatic) and pelvises with implants were excluded in advance. With these preconditions, the inclusion criteria were a fully scanned pelvis, without radiological artifacts, and the patient informed consent. The following inclusion criteria were applied to the initial study cohort: the fifth lumbar vertebra had to be included in the CT scan and the vertebral body had to be clearly defined and exhibit no degenerative changes in L5, or a sacralization or lumbalization of vertebral bodies; the S1 and S2 screw corridors (as defined below) did not interfere with the cortical boundary. This resulted in a final study cohort of 324 datasets. The mean age and standard deviation of the study population was 60.4 ± 17.6 years (17 to 93 years); 49 datasets were for patients of unknown age. There were 107 female (33%) and 217 male (67%) patients.

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confidence: 99%

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Thiesen

Ntalos

Berger-Groch

et al. 2020

Sci Rep

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“…Thus, the region of interest in S1 must be carefully selected, in order to avoid areas with extreme high or low density. This could be a reason that the values for S1 are less accurate than published values for L1-L2 [17][18][19]. However, the results for S1 comfortably reached significance, too, allowing us to assume that the methodology presented is suitable for both the lumbar and the sacral spine.…”

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confidence: 76%

Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data

et al. 2020

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Purpose Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. Patients and methods Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher − 1, n = 26) was compared with a group with impaired bone density (T-score lower − 1, n = 24). Results A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. Conclusions HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. Level of evidence III.

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“…In our study, the mean BMD value was found to be -3.6 in accordance with these data. Wagner et al (2) examined patients with osteoporosis-related SIF and calculated the bone mass of different parts of the sacrum by using special software with CT. According to this study, the bone mass of the sacrum body is generally decreased.…”

Section: Discussionmentioning

confidence: 99%

“…The most common fractures are seen in the vertebral body, hip and wrist, respectively. In recent years, sacral insufficiency fractures (SIF) have become more prevalent due to the increase in the life expectancy of the elderly population (1)(2)(3) . SIF were firstly described by Lourie in 1982.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Mortality of Osteoporotic Sacral Insufficiency Fractures: A Retrospective Singlecentre Study

Haberal¹,

Şimşek²,

Işık³

2020

jtss

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Objective: The incidence of osteoporosis increases with the ageing of the world population. In recent years, sacral insufficiency fractures (SIF) have become more prevalent due to the increase in life expectancy of the elderly population. The aim of this study was to investigate the incidence and the mortality rates of SIF in elderly patients with osteoporosis. Materials and Methods: The records of patients admitted to our hospital between January 2011 and May 2018 were examined. Medical records, radiological images and reports of 245 patients over 65 years of age who had undergone pelvic computed tomography (CT) or magnetic resonance imaging (MRI) for any reason were retrospectively reviewed. Twenty-six patients (three male, 23 female) over 65 years of age who were proven to have osteoporosis with bone mineral densitometry (BMD) values at the time of diagnosis were included in the study. Results: The mean age at the time of diagnosis was 80,5. MRI was used for diagnosis in 20 patients and CT in six patients. The mean value of BMD was found to be-3.62. The most common type of fracture was B1. Surgery was performed in four patients and conservative treatment in 22 patients. Conclusion: Increased risk of fractures due to osteoporosis also increases the risk of SIF. In our study, the incidence of fractures of sacral insufficiency was found to be 12.44% and 5-year mortality was 26.9%.

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Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass

Cited by 41 publications

References 43 publications

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

The three-dimensional bone mass distribution of the posterior pelvic ring and its key role in transsacral screw placement

Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data

Incidence and Mortality of Osteoporotic Sacral Insufficiency Fractures: A Retrospective Singlecentre Study

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