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Sagittal alignment cut-off values for predicting future fall-related fractures in community-dwelling osteoporotic women

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Abstract

Purpose

Determining the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures is essential for understanding fracture risk and informing clinicians and physical therapists. We determined the optimal cut-off value of sagittal alignment for detecting osteoporotic patients at high risk for fall-related fractures in this study.

Methods

In the retrospective cohort study, we enrolled a total of 255 women aged ≥ 65 years who visited an outpatient osteoporosis clinic. We measured participants’ bone mineral density and sagittal alignment, including sagittal vertical axis (SVA), pelvic tilt, thoracic kyphosis, pelvic incidence, lumbar lordosis, global tilt, and gap score at the initial visit. The cut-off value for sagittal alignment that was significantly associated with fall-related fractures was calculated after using multivariate Cox proportional hazards regression analysis.

Results

Ultimately, 192 patients were included in the analysis. After a mean follow-up of 3.0 years, 12.0% (n = 23) had fractures due to falls. Multivariate Cox regression analysis confirmed that SVA (hazard ratio [HR] = 1.022, 95% confidence interval [CI] = 1.005–1.039) was the only independent predictor of fall-related fracture occurrence. The predictive ability of SVA for the occurrence of fall-related fractures was moderate (area under the curve [AUC] = 0.728, 95% CI = 0.623–0.834), with a cut-off value of 100 mm for SVA. SVA classified by cut-off value was also associated with an increased risk of developing fall-related fractures (HR = 17.002, 95% CI = 4.102–70.475).

Conclusion

We found that assessing the cut-off value of sagittal alignment would be useful information in understanding fracture risk in postmenopausal older women.

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Acknowledgements

The authors would like to thank the participants in the present study and the doctors and physiotherapists at the hospital for their help in data acquisition from 2013 to 2020.

Funding

Grants or contracts from any entity (if not indicated in item #1 above). JSPS KAKENHI Grant Number JP20K19221.

Author information

Authors and Affiliations

  1. School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan

    Ryoma Asahi, Satoshi Yuguchi & Masato Azami

  2. Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan

    Yutaka Nakamura, Yoshinao Koike, Masayoshi Kanai & Satoshi Asano

  3. Department of Rehabilitation, Gunma Paz University, 1-7-1 Tonyamachi, Takasaki City, Gunma, 370-0006, Japan

    Tomohiko Kamo

  4. Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-Machi, Nagano City, Nagano, 381-2227, Japan

    Hirofumi Ogihara

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  1. Ryoma Asahi
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Correspondence to Ryoma Asahi.

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Asahi, R., Nakamura, Y., Koike, Y. et al. Sagittal alignment cut-off values for predicting future fall-related fractures in community-dwelling osteoporotic women. Eur Spine J 32, 1446–1454 (2023). https://doi.org/10.1007/s00586-023-07599-3

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