Skip to main content

Advertisement

SpringerLink
Log in

Mortality among older adults with osteoporotic vertebral fracture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving kyphoplasty were at reduced risk of death but after matching on age and medical complications, patients who received kyphoplasty were at increased risk of death.

Purpose

In previous observational studies, kyphoplasty for treatment of osteoporotic vertebral fractures has been associated with decreased mortality compared to conservative management. The purpose of this research was to determine whether older adults who received kyphoplasty had reduced risk of mortality compared to matched patients who did not.

Methods

Retrospective cohort study of US Medicare enrollees with osteoporotic vertebral fractures between 2017–2019 comparing patients who underwent kyphoplasty to those who did not. We identified 2 control groups a priori: 1) non-augmented patients who met inclusion criteria (group 1); 2) propensity-matched patients on demographic and clinical variables (group 2). We then identified additional control groups using matching for medical complications (group 3) and age + comorbidities (group 4). We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with mortality.

Results

A total of 235,317 patients (mean (± standard deviation) age 81.1 ± 8.3 years; 85.8% female) were analyzed. In the primary analyses, those who received kyphoplasty were at reduced risk of death compared to those who did not: adjusted HR (95% CI) in group 1 = 0.84 (0.82, 0.87); and in group 2 = 0.88 (0.85, 0.91). However, in post hoc analyses, patients who received kyphoplasty were at increased risk of death: adjusted HR (95% CI) in group 3 = 1.32 (1.25, 1.41) and 1.81 (1.58, 2.09) in group 4.

Conclusion

An apparent benefit of kyphoplasty on mortality among patients with vertebral fractures was not present after rigorous propensity matching, illustrating the importance of comparing similar individuals when evaluating observational data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G (2017) Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28:1531–1542. https://doi.org/10.1007/s00198-017-3909-3

    Article  CAS  PubMed  Google Scholar 

  2. Suzuki N, Ogikubo O, Hansson T (2009) The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation. Eur Spine J 18:77–88. https://doi.org/10.1007/s00586-008-0847-y

    Article  PubMed  Google Scholar 

  3. Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92. https://doi.org/10.1007/s00198-018-4732-1

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Jalava T, Sarna S, Pylkkanen L et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260. https://doi.org/10.1359/jbmr.2003.18.7.1254

    Article  PubMed  Google Scholar 

  6. LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES (2022) The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. https://doi.org/10.1007/s00198-021-05900-y

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pinto D, Alshahrani M, Chapurlat R et al (2022) The global approach to rehabilitation following an osteoporotic fragility fracture: A review of the rehabilitation working group of the International Osteoporosis Foundation (IOF) committee of scientific advisors. Osteoporos Int 33:527–540. https://doi.org/10.1007/s00198-021-06240-7

    Article  CAS  PubMed  Google Scholar 

  8. Chou R, Fu R, Dana T, Pappas M, Hart E, Mauer KM (2021) Interventional Treatments for Acute and Chronic Pain: Systematic Review. In Reviews ACE (ed) Report No: 21-EHC030Rockville (MD)

  9. Ebeling PR, Akesson K, Bauer DC et al (2019) The Efficacy and Safety of Vertebral Augmentation: A Second ASBMR Task Force Report. J Bone Miner Res 34:3–21. https://doi.org/10.1002/jbmr.3653

    Article  PubMed  Google Scholar 

  10. McGuire R (2011) AAOS Clinical Practice Guideline: the Treatment of Symptomatic Osteoporotic Spinal Compression Fractures. J Am Acad Orthop Surg 19:183–184. https://doi.org/10.5435/00124635-201103000-00008

    Article  PubMed  Google Scholar 

  11. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568. https://doi.org/10.1056/NEJMoa0900429

    Article  CAS  PubMed  Google Scholar 

  12. Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, Bastian L, Ashraf T, Vrionis F, Evaluation CPF, I, (2011) Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 12:225–235. https://doi.org/10.1016/S1470-2045(11)70008-0

    Article  PubMed  Google Scholar 

  13. Garfin SR, Buckley RA, Ledlie J, Balloon Kyphoplasty Outcomes G (2006) Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine (Phila Pa 1976) 31:2213-2220. https://doi.org/10.1097/01.brs.0000232803.71640.ba

  14. Gold LS, O’Reilly MK, Heagerty PJ, Jarvik JG (2021) Complications and healthcare utilization in commercially-insured osteoporotic vertebral compression fracture patients: a comparison of kyphoplasty versus propensity-matched controls. Spine J 21:1347–1354. https://doi.org/10.1016/j.spinee.2021.03.025

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hinde K, Maingard J, Hirsch JA, Phan K, Asadi H, Chandra RV (2020) Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Radiology 295:96–103. https://doi.org/10.1148/radiol.2020191294

    Article  PubMed  Google Scholar 

  16. Levesque LE, Hanley JA, Kezouh A, Suissa S (2010) Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ 340:b5087. https://doi.org/10.1136/bmj.b5087

    Article  PubMed  Google Scholar 

  17. O’Reilly MK, Heagerty PJ, Gold LS, Kallmes DF, Jarvik JG (2020) Augmented Reality. AJNR Am J Neuroradiol 41:E67–E68. https://doi.org/10.3174/ajnr.A6587

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Tyrer F, Bhaskaran K, Rutherford MJ (2022) Immortal time bias for life-long conditions in retrospective observational studies using electronic health records. BMC Med Res Methodol 22:86. https://doi.org/10.1186/s12874-022-01581-1

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yadav K, Lewis RJ (2021) Immortal Time Bias in Observational Studies. JAMA 325:686–687. https://doi.org/10.1001/jama.2020.9151

    Article  PubMed  Google Scholar 

  20. (1990) ICD-9-CM. International Classification of Diseases, 9th revision, Clinical Modification. 3d edition, volumes 1, 2 and 3. Official authorized addendum effective October 1, 1990--HCFA. J Am Med Rec Assoc 61:suppl 1–35

  21. Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, Oliveira RP, de Barros Filho TE (2013) Fractures of the cervical spine Clinics (Sao Paulo) 68:1455–1461. https://doi.org/10.6061/clinics/2013(11)12

    Article  PubMed  Google Scholar 

  22. Torlincasi AM, Waseem M (2020) Cervical Injury. Treasure Island (FL)

  23. Gilbert T, Neuburger J, Kraindler J et al (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 391:1775–1782. https://doi.org/10.1016/S0140-6736(18)30668-8

    Article  PubMed  PubMed Central  Google Scholar 

  24. Edidin AA, Ong KL, Lau E, Kurtz SM (2015) Morbidity and Mortality After Vertebral Fractures: Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population. Spine (Phila Pa 1976) 40:1228-1241. https://doi.org/10.1097/BRS.0000000000000992

  25. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682. https://doi.org/10.1093/aje/kwq433

    Article  PubMed  Google Scholar 

  26. Ashworth J, Green DJ, Dunn KM, Jordan KP (2013) Opioid use among low back pain patients in primary care: Is opioid prescription associated with disability at 6-month follow-up? Pain 154:1038–1044. https://doi.org/10.1016/j.pain.2013.03.011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Jarvik JG, Gold LS, Comstock BA et al (2015) Association of early imaging for back pain with clinical outcomes in older adults. JAMA 313:1143–1153. https://doi.org/10.1001/jama.2015.1871

    Article  CAS  PubMed  Google Scholar 

  28. Feenstra H, Grobbee RE, in’t Veld BA, Stricker BH (2001) Confounding by contraindication in a nationwide cohort study of risk for death in patients taking ibopamine. Ann Intern Med 134:569–572. https://doi.org/10.7326/0003-4819-134-7-200104030-00010

    Article  CAS  PubMed  Google Scholar 

  29. Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA (2018) Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials? Osteoporos Int 29:375–383. https://doi.org/10.1007/s00198-017-4281-z

    Article  CAS  PubMed  Google Scholar 

  30. Lange A, Kasperk C, Alvares L, Sauermann S, Braun S (2014) Survival and cost comparison of kyphoplasty and percutaneous vertebroplasty using German claims data. Spine (Phila Pa 1976) 39:318–326. https://doi.org/10.1097/BRS.0000000000000135

  31. Diamond TH, Bryant C, Browne L, Clark WA (2006) Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 184:113–117. https://doi.org/10.5694/j.1326-5377.2006.tb00148.x

    Article  PubMed  Google Scholar 

  32. Gerling MC, Eubanks JD, Patel R, Whang PG, Bohlman HH, Ahn NU (2011) Cement augmentation of refractory osteoporotic vertebral compression fractures: survivorship analysis. Spine (Phila Pa 1976) 36:E1266–1269. https://doi.org/10.1097/BRS.0b013e31820a0b3f

  33. Lin JH, Chien LN, Tsai WL, Chen LY, Chiang YH, Hsieh YC (2017) Early vertebroplasty associated with a lower risk of mortality and respiratory failure in aged patients with painful vertebral compression fractures: a population-based cohort study in Taiwan. Spine J 17:1310–1318. https://doi.org/10.1016/j.spinee.2017.05.001

    Article  PubMed  Google Scholar 

  34. McDonald RJ, Achenbach SJ, Atkinson EJ, Gray LA, Cloft HJ, Melton LJ 3rd, Kallmes DF (2011) Mortality in the vertebroplasty population. AJNR Am J Neuroradiol 32:1818–1823. https://doi.org/10.3174/ajnr.A2616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Lotan R, Smorgick Y, Anekstein Y, Rudik O, Prosso I, Hershkovich O (2022) Kyphoplasty for Elderly Patients With Vertebral Compression Fractures-Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort. Global Spine J 12:1443–1448. https://doi.org/10.1177/2192568220982282

    Article  PubMed  Google Scholar 

  36. Voggenreiter G (2005) Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 30:2806–2812. https://doi.org/10.1097/01.brs.0000190885.85675.a0

  37. Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR (2007) Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone Miner Res 22:447–457. https://doi.org/10.1359/jbmr.061202

    Article  PubMed  Google Scholar 

  38. Yuan WH, Hsu HC, Lai KL (2016) Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 95:e4491. https://doi.org/10.1097/MD.0000000000004491

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Dr. Brook I. Martin for his help with obtaining the data used for these analyses.

Funding

This work was supported by the University of Washington Clinical Learning, Evidence, And Research (CLEAR) Center for Musculoskeletal Disorders, Administrative, Methodologic and Resource Cores and NIAMS/NIH grant P30AR072572. The funding source had no role in the study design, collection, analysis and interpretation of the data, writing of the report, or the decision to submit this article for publication.

Author information

Authors and Affiliations

  1. Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA

    Laura S. Gold & Jeffrey G. Jarvik

  2. Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA

    Laura S. Gold, Pradeep Suri, Patrick J. Heagerty & Jeffrey G. Jarvik

  3. Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA

    Pradeep Suri

  4. Department of Radiology, University of Limerick Hospital Group, Limerick, Ireland

    Michael K. O’Reilly

  5. Department of Radiology Mayo Clinic, Rochester, MN, USA

    David F. Kallmes

  6. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Patrick J. Heagerty

Authors
  1. Laura S. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pradeep Suri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael K. O’Reilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David F. Kallmes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick J. Heagerty
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeffrey G. Jarvik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura S. Gold.

Ethics declarations

Statement of Human and Animal Rights

In accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments, this study was determined to be exempt from review by the University of Washington Institutional Review Board.

Competing interests

Drs. Gold, Suri, O’Reilly, and Heagerty do not have competing interests. David F. Kalmes discloses that he has ownership/stock in Kypheze, LLC; patents involved in spine augmentation; and has received research support and royalties from Medtronic. Dr. Jeffrey G Jarvik reports royalties as a book co-editor from Springer Publishing and travel reimbursement for Faculty Board of Review from GE-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF) and royalties as a chapter author from Wolters Kluwer/UpToDate.

Conflict of interest

Drs. Gold, Suri, O’Reilly, and Heagerty do not have competing interests. David F. Kalmes discloses that he has ownership/stock in Kypheze, LLC; patents involved in spine augmentation; and has received research support and royalties from Medtronic. Dr. Jeffrey G Jarvik reports royalties as a book co-editor from Springer Publishing and travel reimbursement for Faculty Board of Review from GE-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF) and royalties as a chapter author from Wolters Kluwer/UpToDate.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 1123 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gold, L.S., Suri, P., O’Reilly, M.K. et al. Mortality among older adults with osteoporotic vertebral fracture. Osteoporos Int 34, 1561–1575 (2023). https://doi.org/10.1007/s00198-023-06796-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-023-06796-6

Keywords

Search

Navigation