Relationship between number of radiological risk factors for delayed union after osteoporotic vertebral fracture and clinical outcomes

Abstract

Summary

This study demonstrated that number of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) added prognostic information for delayed union, kyphotic deformity, and prolonged pain.

Purpose

Delayed union after osteoporotic vertebral fracture (OVF) causes prolonged pain, QOL impairment, progression of collapse, kyphotic deformity, and neurologic impairment. Some specific radiological findings can be useful for predicting delayed union. We aimed to explore the prevalence and concomitance of various types of radiological risk factors for delayed union after osteoporotic vertebral fracture (OVF) and to assess the impact of risk factor number on clinical outcomes.

Methods

A total of 508 patients with fresh OVF from 25 institutes were evaluated. All patients were treated conservatively without surgical interventions. At the 6-month follow-up, the patients were classified into bone union and delayed union groups based on plain X-ray findings. We examined the presence and absence of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) and analyzed clinical outcomes according to numbers of radiological risk factors.

Results

Delayed union was observed in 101 patients (19.9%) at the 6-month follow-up. The most common radiological risk factor was thoracolumbar vertebrae involvement (73.8%), followed by middle column injury (33.9%) and specific MRI findings (T2WI confined high-intensity pattern and diffuse low-intensity pattern) (29.7%). Overall, 85 (16.7%) patients had zero radiological risk factors, 212 (42.7%) had one, 137 (27.0%) had two, and 69 (13.6%) had three. When assessing the number of radiographic risk factors which included the MRI findings (the 3-risk factor method), the odds ratio for delayed union after acute OVF was 5.8 in the 2/3-risk factor group and 13.1 in the 3/3-risk factor group. Even when assessing the number of radiographic risk factors without MRI findings (2-risk factor method), the odds ratio was 3.2 in the 1/2-risk factor group and 10.2 in the 2/2-risk factor group.

Conclusion

Number of radiological risk factors added prognostic information for delayed union, kyphotic deformity, and prolonged pain.

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Availability of data and material

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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 thank the physicians 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.

The authors thank Alison Sherwin, PhD, from Edanz Group (http://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

Funding

The authors thank the grants from the Health and Labour Sciences Research Grants for Comprehensive Research on Aging and Health of Japan (grant no. 200718004B, 200715010B) and the Japan Orthopedics and Traumatology Research Foundation, Inc. (grant no. 270).

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Authors

Contributions

Each author has made substantial contributions as below. Hiromitsu Toyoda: design of the work, analysis of data. Masatoshi Hoshino: design of the work, measurements. Shinji Takahashi: design of the work, measurements. Hidetomi Terai: design of the work. Takashi Namikawa: the acquisition and interpretation of data. Minori Kat: the acquisition and interpretation of data. Akira Matsumura: the acquisition and interpretation of data. Akinobu Suzuki: design of the work. Kazushi Takayama: the acquisition and interpretation of data. Ryuichi Sasaoka: the acquisition and interpretation of data. Hiroyuki Yasuda: the acquisition and interpretation of data. Fumiaki Kanematsu: the acquisition and interpretation of data. Hiroshi Kono: the acquisition and interpretation of data. Tadao Tsujio: the acquisition and interpretation of data, measurements. Hiroaki Nakamura: design of the work.

Corresponding author

Correspondence to Hiromitsu Toyoda.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of Osaka City University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent was obtained from all participants included in the study.

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Toyoda, H., Hoshino, M., Takahashi, S. et al. Relationship between number of radiological risk factors for delayed union after osteoporotic vertebral fracture and clinical outcomes. Arch Osteoporos 16, 20 (2021). https://doi.org/10.1007/s11657-021-00884-y

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Keywords

  • Osteoporotic vertebral fractures
  • Delayed union
  • Risk factors
  • Prognosis
  • Magnetic resonance imaging
  • Pain