Risk factors for the development of vertebral fractures after percutaneous vertebroplasty

Abstract

We have recently observed an increased risk for vertebral fractures (VF) in a randomized controlled trial comparing the analgesic effect of vertebroplasty (VP) versus conservative treatment in symptomatic VF. The aim of the present study was to evaluate the risk factors related to the development of VF after VP in these patients. We evaluated risk factors including age, gender, bone mineral density, the number, type, and severity of vertebral deformities at baseline, the number of vertebral bodies treated, the presence and location of disk cement leakage, bone remodeling (determining bone turnover markers) and 25 hydroxyvitamin D [25(OH)D] levels at baseline in all patients. Twenty-nine radiologically new VF were observed in 17 of 57 patients undergoing VP, 72% adjacent to the VP. Patients developing VF after VP showed an increased prevalence of 25(OH)D deficiency (<20 ng/mL) and higher P1NP values. The principal factor related to the development of VF after VP in multivariate analysis was 25(OH)D levels < 20 ng/mL (RR, 15.47; 95% CI, 2.99-79.86, p < 0.0001), whereas age >80 years (RR, 3.20; 95% CI, 1.70-6.03, p ¼ 0.0007) and glucocorticoid therapy (RR, 3.64; 95% CI, 1.61-8.26, p ¼ 0.0055) constituted the principal factors in the overall study population. Increased risk of VF after VP was also associated with cement leakage into the inferior disk (RR, 6.14; 95% CI, 1.65-22.78, p ¼ 0.044) and more than one vertebral body treated during VP (RR, 4.19; 95% CI, 1.03-34.3, p ¼ 0.044).In conclusion, nearly 30% of patients with osteoporotic VF treated with VP had a new VF after the procedure. Age, especially >80 years, the presence of inferior disk cement leakage after the procedure, the number of cemented vertebrae, and low 25(OH)D serum levels were related to the development of new VF in these patients, with the latter indicating the need to correct vitamin D deficiency prior to performing VP.

Risk factors for new vertebral compression fractures after vertebroplasty: a meta‐analysis

“…After reviewing the full text of the remaining 26 studies, we excluded nine additional full‐text articles. Finally, 17 unique studies with sufficient data were included and analysed in the meta‐analysis . A flow diagram that shows the literature search process is presented in Figure .…”

“…The descriptive statistics for the studies that were included in our meta‐analysis are summarized in Table . Of the studies, eight were conducted in China, six were conducted in Korea, one was conducted in the Netherlands, one was conducted in Japan and one was conducted in Spain . The results of the quality assessment are summarized as follows: two studies received a score of 9, eight studies received a score of 8, five studies received a score of 7 and two studies received a score of 6.…”

“…The 17 studies included 521 cases and 1774 controls, for a total of 2295 participants. Of the studies, 15 reported the incidence of new VCFs after vertebroplasty. The reported incidence of subsequent VCFs following vertebroplasty ranged from 6.81 to 37.95%.…”

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

“…On the basis of different inclusion criteria, studies have reported the risk of an adjacent fracture after PVP may increase with a lower BMD (6,(16)(17)(18), greater age (16,19), female gender, and cement leakage to disc (19,20), intervertebral vacuum (16), lower BMI (21), increased preoperative segmental kyphosis (22), greater anterior height restoration rate (18), the distribution of cement within the fracture (23) and a larger number of fractures (17,(23)(24)(25).…”

Nomogram for Predicting Intradiscal Cement Leakage Following Percutaneous Vertebroplasty in Patients with Osteoporotic Related Vertebral Compression Fractures

“…Intradiscal cement leakage (ICL) has been associated with each of the Tome-Bermejo categories in new adjacent and non-adjacent vertebral compression fractures. Pain with this leakage can reduce the quality of patients' lives (22)(23)(24)(25)(26). The risk factors for ICL are still under debate (19,(27)(28)(29).…”