Difference of clinical course between cases with bone union and those with delayed union following osteoporotic vertebral fractures
In this prospective multicenter study of osteoporotic vertebral fractures (OVFs), delayed union of OVF at 6-month follow-up caused prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression.
Delayed union following osteoporotic vertebral fracture displayed as an intravertebral cleft on plain X-rays was reported to be a factor for prolonged severe pain. However, the difference of clinical course between bone union and delayed union cases still remains unclear. The purpose of this study was to identify how OVF delayed union following conventional conservative treatment influences the clinical course with a prospective multicenter study.
A total of 324 OVF patients from 25 institutes in Osaka, Japan, were included in the study. At the 6-month follow-up after initial visit to each institute, the patients were classified into bone union and delayed union groups based on plain X-ray findings. The outcome assessments included a VAS for back pain, SF-36 for quality of life (QOL), severity of bed-ridden state for activities of daily living (ADL), MMSE for cognitive functions, and degree of vertebral collapse on plain X-rays.
Overall, 280 patients were included into the union group and 44 into the delayed union group. The VAS score at 6 months was significantly worse in the delayed union group (p = 0.01). The scores for the SF-36 scales of physical functioning and bodily pain at 6 months were significantly lower in the delayed union group (p = 0.019, p = 0.01, respectively). The percentage of nearly or completely bed-ridden patients was significantly higher in the delayed union group. The percentage of newly developed cognitive impairment was significantly higher in the delayed union group (p = 0.02). Progression of vertebral collapse during the 6-month follow-up was more pronounced in the delayed union group (p < 0.01).
The present results revealed that delayed union following OVF causes prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression.
KeywordsOsteoporosis Vertebral fracture Clinical course Delayed union Dementia Vertebral collapse
The authors thank Masami Tatsumi, Tomomi Tanaka, Tomoko Komaru, Aki Tanaka, Asami Satou, and Keiko Yoneda for their help in the collection of data and interviews with the patients. The authors also express their sincere thanks to the doctors from Osaka City General Hospital, Osaka City Juso Hospital, Osaka City Kita Hospital, Osaka City Sumiyoshi Hospital, Kousaiin Hospital, Hujiidera Municipal Hospital, Izumi Municipal Hospital, Aeba Surgical Hospital, Yodogawa Christian Hospital, Ishikiri Seiki Hospital, Asakayama Hospital, Osaka Ekisaikai Hospital, Kyouwa Hospital, Saiseikai Nakatsu Hospital, Saiseikai Senri Hospital, Baba Memorial Hospital, Seikeikai Hospital, Nagayoshi Sougou Hospital, Nishinomiya Watanabe Hospital, Hankai Hospital, Higashisumiyoshi Morimoto Hospital, Shitennoji Hospital, Satou Hospital, and Tsujigeka Hospital for enrolling the patients in this prospective study.
Compliance with ethical standards
The study design was preapproved by the Ethical Committee for Clinical Research at the respective institutes. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.
Conflicts of interest
- 2.Cohen L (1990) Fractures of the osteoporotic spine. Orthop Clin N Am 21(1):143–150Google Scholar
- 3.El Maghraoui A, Sadni S, Jbili N, Rezqi A, Mounach A, Ghozlani I (2014) The discriminative ability of FRAX, the WHO algorithm, to identify women with prevalent asymptomatic vertebral fractures: a cross-sectional study. BMC Musculoskelet Disord 15(1):365. https://doi.org/10.1186/1471-2474-15-365 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Lafforgue P, Chagnaud C, Daumen-Legré V, Daver L, Kasbarian M, Acquaviva P (1997) The intravertebral vacuum phenomenon (“vertebral osteonecrosis”). Migration of intradiscal gas in a fractured vertebral body? Spine (Phila Pa 1976) 22(16):1885–1891. https://doi.org/10.1097/00007632-199708150-00015 CrossRefGoogle Scholar
- 14.Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BEC, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Eis SR, Gennari C, Johnell O, Johnston Jr CC, Lau EMC, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Miller PD, Mithal A, Morii H, Papapoulos S, Woolf A, Yu W, Khaltaev N (1999) Interim report and recommendations of the World Health Organization task-force for osteoporosis. Osteoporos Int 10(4):259–264. https://doi.org/10.1007/s001980050224 CrossRefPubMedGoogle Scholar
- 15.(1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Executive summary. Osteoporos Int 8 Suppl 4:S3–6Google Scholar
- 18.Toyone T, Tanaka T, Wada Y et al (2006) Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 31(25):2963–2966. https://doi.org/10.1097/01.brs.0000247802.91724.7e CrossRefGoogle Scholar
- 19.Begerow B, Pfeifer M, Pospeschill M, Scholz M, Schlotthauer T, Lazarescu A, Pollaehne W, Minne H (1999) Time since vertebral fracture: an important variable concerning quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 10(1):26–33. https://doi.org/10.1007/s001980050190 CrossRefPubMedGoogle Scholar
- 22.Nevitt M, Ettinger B, Black D, Stone K, Jamal S, Ensrud K, Segal M, Genant H, Cummings S (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128(10):793–800. https://doi.org/10.7326/0003-4819-128-10-199805150-00001 CrossRefPubMedGoogle Scholar
- 23.Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7(4):449–456. https://doi.org/10.1002/jbmr.5650070413 CrossRefPubMedGoogle Scholar
- 29.Kawaguchi S, Horigome K, Yajima H, Oda T, Kii Y, Ida K, Yoshimoto M, Iba K, Takebayashi T, Yamashita T (2010) Symptomatic relevance of intravertebral cleft in patients with osteoporotic vertebral fracture. J Neurosurg Spine 13(2):267–275. https://doi.org/10.3171/2010.3.SPINE09364 CrossRefPubMedGoogle Scholar
- 30.Hoshino M, Nakamura H, Terai H, Tsujio T, Nabeta M, Namikawa T, Matsumura A, Suzuki A, Takayama K, Takaoka K (2009) Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 18(9):1279–1286. https://doi.org/10.1007/s00586-009-1041-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Jang JS, Kim DY, Lee SH (2003) Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body. Spine (Phila Pa 1976) 28(14):1588–1592. https://doi.org/10.1097/01.BRS.0000076824.61074.06 CrossRefGoogle Scholar
- 32.Murata K, Watanabe G, Kawaguchi S, Kanaya K, Horigome K, Yajima H, Morita T, Yamashita T (2012) Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support. J Neurosurg Spine 17(5):469–475. https://doi.org/10.3171/2012.7.SPINE122 CrossRefPubMedGoogle Scholar
- 35.Hayashi T, Maeda T, Masuda M, Ueta T, Shiba K (2016) Morphology of the injured posterior wall causing spinal canal encroachment in osteoporotic vertebral fractures. Spine JGoogle Scholar