TY - JOUR
T1 - Risk factors of nonunion after acute osteoporotic vertebral fractures
T2 - A prospective multicenter cohort study
AU - Inose, Hiroyuki
AU - Kato, Tsuyoshi
AU - Ichimura, Shoichi
AU - Nakamura, Hiroaki
AU - Hoshino, Masatoshi
AU - Togawa, Daisuke
AU - Hirano, Toru
AU - Tokuhashi, Yasuaki
AU - Ohba, Tetsuro
AU - Haro, Hirotaka
AU - Tsuji, Takashi
AU - Sato, Kimiaki
AU - Sasao, Yutaka
AU - Takahata, Masahiko
AU - Otani, Koji
AU - Momoshima, Suketaka
AU - Yuasa, Masato
AU - Hirai, Takashi
AU - Yoshii, Toshitaka
AU - Okawa, Atsushi
N1 - Funding Information:
Acknowledgment date: August 30, 2019. First revision date: October 6, 2019. Second revision date: November 13, 2019. Acceptance date: December 16, 2019. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. The manuscript submitted does not contain information about medical device(s)/drug(s). Grants-in-Aid from the Japan Agency for Medical Research and Development (grant number 16dk0110008h0003) funds were received in support of this work. Relevant financial activities outside the submitted work: board membership. Address correspondence and reprint requests to Hiroyuki Inose, MD, PhD, Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; E-mail: inose.orth@tmd.ac.jp
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Study Design.Prospective cohort study.Objective.To characterize a patient population with nonunion after acute osteoporotic vertebral fractures (OVFs) and compare the union and nonunion groups to identify risk factors for nonunion.Summary of Background Data.While OVFs are the most common type of osteoporotic fracture, the predictive value of a clinical assessment for nonunion at 48 weeks after OVF has not been extensively studied.Methods.This prospective multicenter cohort study included female patients aged 65 to 85 years with acute one-level osteoporotic compression fractures. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and at 48 weeks to confirm the diagnosis and union status. The patient-reported outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), a visual analogue scale for low back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at 0, 12, and 48 weeks.Results.In total, 166 patients completed the 12-month follow-up, 29 of whom had nonunion. Patients with nonunion at 48 weeks after OVF had lower EQ-5D and JOABPEQ walking ability, social life function, mental health, and lumbar function scores than those with union at 48 weeks after injury. The independent risk factors for nonunion after OVF in the acute phase were a diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI. The anterior vertebral body compression percentage and JOABPEQ social life function scores were independent risk factors at 12 weeks.Conclusion.A diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI were independent risk factors for nonunion in the acute phase. Patients who have acute OVFs with these risk factors should be carefully monitored for nonunion.Level of Evidence: 2.
AB - Study Design.Prospective cohort study.Objective.To characterize a patient population with nonunion after acute osteoporotic vertebral fractures (OVFs) and compare the union and nonunion groups to identify risk factors for nonunion.Summary of Background Data.While OVFs are the most common type of osteoporotic fracture, the predictive value of a clinical assessment for nonunion at 48 weeks after OVF has not been extensively studied.Methods.This prospective multicenter cohort study included female patients aged 65 to 85 years with acute one-level osteoporotic compression fractures. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and at 48 weeks to confirm the diagnosis and union status. The patient-reported outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), a visual analogue scale for low back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at 0, 12, and 48 weeks.Results.In total, 166 patients completed the 12-month follow-up, 29 of whom had nonunion. Patients with nonunion at 48 weeks after OVF had lower EQ-5D and JOABPEQ walking ability, social life function, mental health, and lumbar function scores than those with union at 48 weeks after injury. The independent risk factors for nonunion after OVF in the acute phase were a diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI. The anterior vertebral body compression percentage and JOABPEQ social life function scores were independent risk factors at 12 weeks.Conclusion.A diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI were independent risk factors for nonunion in the acute phase. Patients who have acute OVFs with these risk factors should be carefully monitored for nonunion.Level of Evidence: 2.
KW - Kyphosis
KW - Low back pain
KW - Nonunion
KW - Osteoporotic vertebral fracture
KW - Patient-reported outcome measures
KW - Quality of life
KW - Radiographic assessments
KW - Risk factors
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U2 - 10.1097/BRS.0000000000003413
DO - 10.1097/BRS.0000000000003413
M3 - Article
C2 - 32044808
AN - SCOPUS:85086524713
VL - 45
SP - 895
EP - 902
JO - Spine
JF - Spine
SN - 0362-2436
IS - 13
ER -
