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Risk factors for subsequent vertebral fracture after acute osteoporotic vertebral fractures

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Abstract

Purpose

To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures.

Methods

This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed.

Results

Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65–85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment.

Conclusion

Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures.

Level of evidence

III

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Acknowledgements

The authors thank Tomoko Nakajima for her help with data collection, Dr. Makoto Tomita for his help with the statistical analysis, and Dr. Ukihide Tateishi for his help with the radiological analysis.

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan

    Hiroyuki Inose

  2. Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan

    Tsuyoshi Kato

  3. Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan

    Tsuyoshi Kato, Masato Yuasa, Takashi Hirai, Toshitaka Yoshii & Atsushi Okawa

  4. Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan

    Shoichi Ichimura

  5. Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, 545-8585, Japan

    Hiroaki Nakamura & Masatoshi Hoshino

  6. Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan

    Daisuke Togawa

  7. Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan

    Toru Hirano

  8. Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan

    Yasuaki Tokuhashi

  9. Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan

    Tetsuro Ohba & Hirotaka Haro

  10. Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan

    Takashi Tsuji

  11. Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan

    Kimiaki Sato

  12. Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan

    Yutaka Sasao

  13. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan

    Masahiko Takahata

  14. Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan

    Koji Otani

  15. Department of Diagnostic Radiology, Center for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan

    Suketaka Momoshima

  16. Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan

    Kunihiko Takahashi

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  1. Hiroyuki Inose
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Contributions

Hiroyuki Inose, Tsuyoshi Kato, Shoichi Ichimura, Hiroaki Nakamura, Masatoshi Hoshino, Daisuke Togawa, Toru Hirano, Yasuaki Tokuhashi, Tetsuro Ohba, Hirotaka Haro, Takashi Tsuji, Kimiaki Sato, Yutaka Sasao, Masahiko Takahata, Koji Otani, Suketaka Momoshima, Kunihiko Takahashi, Masato Yuasa, Takashi Hirai, Toshitaka Yoshii, and Atsushi Okawa (1) provided substantial contributions to the conception or design of the study or the acquisition, analysis, or interpretation of data; (2) drafted the paper or revised it critically for important intellectual content, (3) provided final approval of the version to be published; and (4) agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Hiroyuki Inose.

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Inose, H., Kato, T., Ichimura, S. et al. Risk factors for subsequent vertebral fracture after acute osteoporotic vertebral fractures. Eur Spine J 30, 2698–2707 (2021). https://doi.org/10.1007/s00586-021-06741-3

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