Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

Abstract

Study Design: Prospective study. Objectives: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. Summary of Literature Review: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. Materials and Methods: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb's angle. Results: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). Conclusion: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

Clinical and radiological outcomes of denosumab and teriparatide treatment in elderly patients with osteoporotic spinal compression fracture without vertebroplasty

“…Based on previous studies, it has been known that osteoporotic spinal fractures have a relatively good prognosis, and acute pain disappears after 6 to 8 weeks, without causing severe physical or emotional impairment [1,6]. However, recent studies also reported that, once occurred, fracture results in physical and emotional disability in many patients, causing limitations in daily life due to persistent pain, loss of confidence, and depression even after recovery [1,4,19].…”

“…Based on previous studies, it has been known that osteoporotic spinal fractures have a relatively good prognosis, and acute pain disappears after 6 to 8 weeks, without causing severe physical or emotional impairment [1,6]. However, recent studies also reported that, once occurred, fracture results in physical and emotional disability in many patients, causing limitations in daily life due to persistent pain, loss of confidence, and depression even after recovery [1,4,19]. Furthermore, the progression of vertebral body compression may cause digestive disorders, such as early satiety and weight loss, due to decreased abdominal cavity volume following costal margin displacement towards the iliac crest, or due to hepatic function deterioration following pleural compression [1][2][3].…”

“…However, recent studies also reported that, once occurred, fracture results in physical and emotional disability in many patients, causing limitations in daily life due to persistent pain, loss of confidence, and depression even after recovery [1,4,19]. Furthermore, the progression of vertebral body compression may cause digestive disorders, such as early satiety and weight loss, due to decreased abdominal cavity volume following costal margin displacement towards the iliac crest, or due to hepatic function deterioration following pleural compression [1][2][3]. For these reasons, vertebroplasty is selectively being performed, as they have been reported to be excellent in acute pain control and early functional recovery as alternatives to conservative treatments, including bed rest, administration of anti-inflammatory drugs, walking with braces, and lifestyle training [15,20].…”

“…For these reasons, vertebroplasty is selectively being performed, as they have been reported to be excellent in acute pain control and early functional recovery as alternatives to conservative treatments, including bed rest, administration of anti-inflammatory drugs, walking with braces, and lifestyle training [15,20]. Despite this, there are many studies that still advocate for the use of conservative treatment due to the complications of the procedure itself, including bone cement outflow, vertebral body osteonecrosis, recompression, infection, and additional fractures to the adjacent vertebrae [1,10,19,21].…”

“…Osteoporosis is a widespread skeletal system disease, in which fractures easily occur due to low bone mass and structural aging, causing chronic back pain, spinal deformity, and fractures. Particularly, when accompanied by osteoporosis, spinal compression fractures can result from even a mild trauma or without any noticeable trauma, which is known to occur in 25% of all females over the age of 70 and 50% of all females over the age of 80 [1][2][3]. In the past, osteoporotic spinal compression fractures were thought to recover spontaneously without specific complications; however, with the recent increasing aging population and more osteoporosis-focused studies, these fractures are now reported to have physical, functional, and psychological sequelae, as well as cause serious complications, such as reduced quality of life and increased mortality, suggesting the need for an active therapeutic approach alongside osteoporosis treatment [1,4,5].…”