Archives of Osteoporosis

, 13:95 | Cite as

Global sagittal alignment in elderly patients with osteoporosis and its relationship with severity of vertebral fracture and quality of life

  • Zongshan Hu
  • Gene C. W. Man
  • Anthony K. L. Kwok
  • Sheung-Wai Law
  • Winnie W. C. Chu
  • Wing-Hoi Cheung
  • Yong Qiu
  • Jack C. Y. ChengEmail author
Original Article



We compared global sagittal alignment and quality of life in osteoporotic patients with and without vertebral compression fracture (VCF) and determined its relationship with VCF severity. The findings revealed osteoporotic patients with VCF showed decreased quality of life and worse global sagittal alignment, which was significantly associated with VCF severity.


The aim of this study was to compare the global sagittal alignment and quality of life in elderly osteoporotic patients with and without vertebral compression fracture (VCF), and to investigate the relationship between global sagittal alignment and severity of VCF.


A consecutive series of 72 female patients with osteoporosis aged over 60 years and 31 age-matched females without osteoporosis were prospectively enrolled. The patients were divided into VCF and non-VCF group. Patient’s clinical demography, nature of VCF, and bone mineral density (BMD) were also recorded. Spinal deformity index was used to evaluate severity of VCF. EOS® biplanar imaging system was then used to evaluate global sagittal parameters: T1 pelvic angle (TPA) and global sagittal angle (GSA). In addition, quality of life was assessed with self-reported questionnaires: the Oswestry Disability Index (ODI) and Short-form 12 (SF-12).


Osteoporotic patients and controls were found to be significantly different in terms of TPA, GSA, and BMD. And in patients with VCF, they were found to have significantly higher TPA and GSA. TPA and GSA were significantly correlated with SF-12 and ODI. The number of VCF and SDI significantly correlated with global sagittal alignment. Using regression analysis, parameters significantly associated with abnormal global alignment were the number of VCF (OR = 1.13) and SDI (OR = 1.84).


Osteoporotic patients with VCF showed worse global sagittal alignment and decreased quality of life. The number and severity of VCF had a negative influence on global sagittal balance, which indicates that poorer sagittal global alignment may imply worse quality of life and more severe VCF.


Global sagittal alignment Osteoporosis Vertebral compression fracture Quality of life Spinal deformity index 


Compliance with ethical standards

Conflict of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Zongshan Hu
    • 1
    • 2
  • Gene C. W. Man
    • 1
    • 2
  • Anthony K. L. Kwok
    • 1
  • Sheung-Wai Law
    • 1
  • Winnie W. C. Chu
    • 2
    • 3
  • Wing-Hoi Cheung
    • 1
    • 2
  • Yong Qiu
    • 2
    • 4
  • Jack C. Y. Cheng
    • 1
    • 2
    Email author
  1. 1.Department of Orthopaedics and Traumatology, Faculty of MedicineThe Chinese University of Hong Kong, Prince of Wales HospitalShatinChina
  2. 2.The Joint Scoliosis Research Center of the Chinese University of Hong Kong–Nanjing UniversityShatinChina
  3. 3.Department of Imaging and Interventional Radiology, Prince of Wales HospitalShatinChina
  4. 4.Spine Surgery, Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina

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