Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2012 Dec;19(4):138-144. Korean.
    Published online Dec 31, 2012.
    https://doi.org/10.4184/jkss.2012.19.4.138
    © Copyright 2012 Korean Society of Spine Surgery
    Original Article

    Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

    Young Do Koh, M.D., Jong-Oh Kim, M.D., Rag Gyu Kim, M.D., Dae Youn Kim, M.D., Nam-Ki Kim, M.D. and Dong Jun Kim, M.D.
      • Department of Orthopedic Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
    • Corresponding author: Dong Jun Kim, M.D. Department of Orthopedic Surgery, Ewha Womans Mokdong Hospital, Anyangcheonno 1071 Yangcheon-gu, Seoul, Korea. TEL: 82-2-2650-2873, FAX: 82-2-2642-0349, Email: djkim@ewha.ac.kr
    Received May 28, 2012; Revised October 11, 2012; Accepted December 10, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    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 the 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.

    Keywords
    Osteoporotic vertebral fracture; Conservative management; Survival analysis; Prognostic factor

    Figures

    Fig. 1
    Measurement of vertebral compression ratio by the following formula, [(A+C)/2-B]/[(A+C)/2].

    *A: anterior vertebral height of upper vertebra, B: anterior vertebral height of fracture level, C: anterior vertebral height of lower vertebra.

    Fig. 2
    Measurement of regional Cobb's angle on plain radiograph.

    Fig. 3
    The Survival rate was 91.5% at 2 weeks, 78.5% at 1month, 72.3% at 2months, and 70.7% at 3months.

    Fig. 4
    Univariate Analysis. (A) Age, (B) Fracture types, (C) Bone mineral density.

    Tables

    Table 1
    Results of univariate analysis

    Table 2
    Results of multivariate analysis

    References

      1. Kim SW, Chung YK. Longterm follow-up osteoporotic vertebral fractures according to the morphologic analysis of fracture pattern. J Korean Soc Spine Surg 2000;7:611–617.
      1. Melton LJ 3rd, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–1011.
      1. Reid DC, Hu R, Davis LA, Saboe LA. The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma 1988;28:1188–1194.
      1. Westerborn A, Olsson O. Mechanics, treatment and prognosis of fractures of the dorso-lumbar spine. Acta Chir Scand 1951;102:59–83.
      1. Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998;8:261–267.
      1. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141:68–71.
      1. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999;159:1215–1220.
      1. Jung HW, Park JY, Kim KJ, Lee JC, Kim YI, Shin BJ. Conservative treatment of compression and stable burst fractures in the thoracolumbar junction : early ambulation Vs. late ambulation. J Korean Orthop Assoc 2002;37:483–488.
      1. Suk SI, Lee CK, Kang HS, et al. Vertebral fracture in Osteoporosis. J Korean Orthop Assoc 1993;28:980–987.
      1. Weinstein JN, Collalto P, Lehman TR. Thoracolumbar "burst" fractures treated conservatively : a long-term follow-up. Spine (Phila Pa 1976) 1988;13:33–38.
      1. Kim WJ, Kang JW, Park KY, Park JG, Jung SH, Choy WS. Clinical outcome of conservative treatment for osteoporotic compression fractures in thoracolumbar junction. J Korean Soc Spine Surg 2006;13:240–246.
      1. Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 2003;114:257–265.
      1. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976) 2001;26:1511–1515.
      1. Truumees E. Osteoporosis. Spine (Phila Pa 1976) 2001;26:930–932.
      1. Park HG, Kim MH, Yoo MJ, et al. Complications after vertebroplasty of treatment for compression fracture with osteoporosis. J Korean Soc Fract 2003;16:534–540.
      1. Wenger M, Markwalder TM. Re: Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976) 2000;25:2968–2969.
      1. Bengner U, Johnell O, Redlund-Johnell I. Changes in incidence and prevalence of vertebral fracture during 30 years. Calcif Tissue Int 1988;42:293–296.
      1. Lindsay R, Burge RT, Strauss DM. One year outcomes and costs following a vertebral fracture. Osteoporos Int 2005;16:78–85.
      1. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 2000;39:1410–1414.
      1. Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17 5 Suppl:505S–511S.
      1. Cyteval C, Sarrabere MP, Roux JO, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. AJR Am J Roentgenol 1999;173:1685–1690.
      1. Yamazaki K, Kushida K, Kin K, et al. Bone mineral density of the spine and femoral neck fracture in normal japanese subjects using X-ray absoptiometry. J Bone Miner Res 1989;4:228.
      1. Lyritis GP, Mayasis B, Tsakalakos N, et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 1989;8:66–69.
      1. Ismail AA, Cooper C, Felsenberg D, et al. European Vertebral Osteoporosis Study Group. Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. Osteoporos Int 1999;9:206–213.
      1. Yamato M, Nishimura G, Kuramochi E, Saiki N, Fujioka M. MR appearance at different ages of osteoporotic compression fractures of the vertebrae. Radiat Med 1998;16:329–334.
      1. Kanchiku T, Taguchi T, Kawai S. Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fracture. J Orthop Sci 2003;8:463–466.
      1. Sohn JM, Kim KW, Ha KY, Ha NK, Kim YH, Kim JH. Risk factors for the progressive osteoporotic spinal fracture. J Korean Soc Spine Surg 2009;16:153–159.
      1. Ahn DK, Lee S, Choi DJ, Park HS, Kim KS, Kim TW. The efficacy of kyphoplasty on osteoporotic vertebral compression fracture: a 1-year follow-up study. J Korean Soc Spine Surg 2009;16:79–88.
        Roukis TS, Hurless JS. The hallucal interphalangeal sesamoid. J Foot Ankle Surg. 1996;35:303-8.
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    MeSH Terms
    Age Factors
    Body Mass Index
    Bone Density
    Humans
    Osteoporosis
    Prognosis
    Prospective Studies
    Smoke
    Smoking
    Survival Analysis
    Survival Rate
    Metrics
    Share
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