Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method

Hirsch, Joshua A; Beall, Douglas P.; Chambers, M. R.; Andreshak, Thomas G.; Brook, Allan; Bruel, Brian M.; Deen, H. Gordon; Gerszten, Peter C.; Kreiner, D. Scott; Sansur, Charles A.; Tutton, Sean; Meer, Peter van der; Stoevelaar, Herman

doi:10.1016/j.spinee.2018.07.025

Cited by 40 publications

(26 citation statements)

References 34 publications

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“…As a consequence, the presence of such disabling symptoms may interfere with activities of daily living and significantly reduce the patient's perceived quality of life (22). Moreover, it is well known that the ankylosed spine in patients with DISH is prone to unstable fractures due to long lever arms and consecutive stress concentration (23), thus exposing patients to a considerable risk of secondary spinal cord injury (24,25) and increased mortality (26). A recent multicentre study on 285 patients with DISH showed that trivial trauma accounts for 77.2% of spinal fractures in this clinical setting, with delayed diagnosis being significantly associated with neurological deterioration and subsequent disability (27).…”

Section: Discussionmentioning

confidence: 99%

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis

Ambrosino¹,

Scrutinio²,

Campi³

et al. 2020

J Rehabil Med

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Diffuse idiopathic skeletal hyperostosis (also known as Forestier's disease) is a systemic condition with a wide spectrum of clinical manifestations. Patients with diffuse idiopathic skeletal hyperostosis often experience pain, stiffness, loss of range of motion, and even difficulty breathing or swallowing. As a consequence, the presence of such disabling symptoms may interfere with activities of daily living and significantly reduce perceived quality of life. Moreover, the ankylosed spine in patients with diffuse idiopathic skeletal hyperostosis is prone to unstable fractures, thus exposing patients to a considerable risk of secondary spinal cord injury. This study found an exceptionally high prevalence of diffuse idiopathic skeletal hyperostosis among patients with congestive heart failure who were undergoing cardiac rehabilitation, particularly in obese and older individuals. Given the risk of spinal fractures, even after low impact trauma, and of severe disability, the presence of diffuse idiopathic skeletal hyperostosis should always be investigated in patients with congestive heart failure who report stiffness of the spine or chronic back pain, especially in those undergoing exercise-based activities. Objective: To assess the prevalence of diffuse idiopathic skeletal hyperostosis and its relationship with vascular risk factors among patients with congestive heart failure. Design: Population-based cross-sectional study. Participants: A total of 584 consecutive patients admitted to a Rehabilitative Cardiology Unit. Methods: Chi-square Automatic Interaction Detector (CHAID) decision tree analysis was used to build a predictive model. Results: The mean age (standard deviation) of the study population was 68.1 years (standard deviation 12.3), and 77.7% of the subjects were men. The overall prevalence of diffuse idiopathic skeletal hyperostosis in the cohort was 49.8%. Logistic regression analysis showed that age was a predictor of diffuse idiopathic skeletal hyperostosis (odds ratio 1.034; 95% confidence interval: 1.021-1.047, p < 0.001), with increasing odds ratios for increasing age tertiles. The CHAID prediction model identified 2 age "buckets": ≤ 69 and > 69 years. Patients > 69 years had a diffuse idiopathic skeletal hyperostosis prevalence of 60.1%, compared with 39.2% among those ≤ 69 years. Notably, body mass index was a predictor of diffuse idiopathic skeletal hyperostosis in this younger subset of patients (p = 0.028), with 2 body mass index buckets, ≤ 23.3 and > 23.3 kg/m 2 , the latter showing more than twice the prevalence of diffuse idiopathic skeletal hyperostosis (43.2% vs 20%). Conclusion: Diffuse idiopathic skeletal hyperostosis is extremely frequent among patients with congestive heart failure, with age and body mass index being the strongest predictors.

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Section: Discussionmentioning

confidence: 99%

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis

Ambrosino¹,

Scrutinio²,

Campi³

et al. 2020

J Rehabil Med

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“…Vertebral augmentation was recommended in patients with positive imaging results and also worsening of the symptoms (eg decreased vertebral heights, negative impacts on functioning, etc.) [33]. There is good evidence and consensus about the disease and its complications, but physicians still do not give enough effort for "identification and prevention of osteoporotic VCF's".…”

Section: 2mentioning

confidence: 99%

Vertebral compression fractures: Still an unpredictable aspect of osteoporosis

Kutsal¹,

Ergani²

2021

Turk J Med Sci

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“…MRI of the spine is recommended prior to VA [14]. Edema of the vertebral body ( Fig.1) and spinal canal patency are well evaluated on MRI.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Edema of the vertebral body ( Fig.1) and spinal canal patency are well evaluated on MRI. The presence of edema in the vertebral body increases the likelihood of post-procedural pain relief [14]. MRI can also exclude other conditions that may contribute to the patient's pain, particularly malignancy and discitisosteomyelitis, and helps in pre-procedure planning.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…MRI can also exclude other conditions that may contribute to the patient's pain, particularly malignancy and discitisosteomyelitis, and helps in pre-procedure planning. If the patient is unable to obtain an MRI, a bone scan with SPECT/CT should be obtained [14]. Fractures of the spine or elsewhere manifest as areas of increased tracer uptake on bone scan [15].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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The Pain Crisis: Interventional Radiology's Role in Pain Management

Fletcher

Moore

Stensby

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method

Abstract: Using the RAND/UCLA Appropriateness Method, a multispecialty expert panel established a comprehensive CCP for the management of VFF. The CCP may be helpful to support decision-making in daily clinical practice and to improve quality of care.

Cited by 40 publications

References 34 publications

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis

Diffuse idiopathic skeletal hyperostosis in subjects with congestive heart failure undergoing cardiac rehabilitation: A decision tree analysis

Vertebral compression fractures: Still an unpredictable aspect of osteoporosis

The Pain Crisis: Interventional Radiology's Role in Pain Management

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