Risk factors analysis of adjacent fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zilong ¹ , JING Qiming ¹ , QIAO Rui ¹ , YANG Jiarui ¹ , CHEN Haojie ¹ , QIAN Lixiong ² , ZHANG Xuefang ² , YANG Junsong ² ,  HAO Dingjun ²

1. Xi’an Medical College, Xi’an Shaanxi, 710045, P.R.China;
2. Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Osteoporotic vertebral compression fracture; percutaneous vertebroplasty; complication; adjacent segment; risk factor

DOI：

10.7507/1002-1892.202008044

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Objective To investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods A total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors.Results All patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation (P<0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients (P<0.05).Conclusion The risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.

Citation： ZHANG Zilong, JING Qiming, QIAO Rui, YANG Jiarui, CHEN Haojie, QIAN Lixiong, ZHANG Xuefang, YANG Junsong, HAO Dingjun. Risk factors analysis of adjacent fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 20-25. doi: 10.7507/1002-1892.202008044 Copy

1.	Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol, 2017, 5(7): 513-523.
2.	Yang H, Chen L, Zheng Z, et al. Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study. J Orthop Translat, 2017, 11: 73-77.
3.	Feng L, Feng C, Chen J, et al. The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord, 2018, 19(1): 195.
4.	Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26): B19-26.
5.	Oliveira PP, Marinheiro LP, Wender MC, et al. Prevalence of vertebral fractures and risk factors in women over 60 years of age in Chapecó, Santa Catarina State, Brazil. Cad Saude Publica, 2010, 26(9): 1777-1787.
6.	Warden SJ, Carballido-Gamio J, Avin KG, et al. Adaptation of the proximal humerus to physical activity: A within-subject controlled study in baseball players. Bone, 2019, 121: 107-115.
7.	Eichler MC, Spross C, Ewers A, et al. Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience. J Neurosurg Spine, 2016, 25(4): 528-534.
8.	Iki M. Osteoporosis and smoking. Clin Calcium, 2005, 15(7): 156-158.
9.	Wong PK, Christie JJ, Wark JD. The effects of smoking on bone health. Clin Sci (Lond), 2007, 113(5): 233-241.
10.	Kim KH, Lee CM, Park SM, et al. Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey. Osteoporos Int, 2013, 24(2): 523-532.
11.	Leib ES, Saag KG, Adachi JD, et al. Official positions for FRAX(^®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(^®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(^®). J Clin Densitom, 2011, 14(3): 212-219.
12.	Hubbard R, Tattersfield A, Smith C, et al. Use of inhaled corticosteroids and the risk of fracture. Chest, 2006, 130(4): 1082-1088.
13.	Graat-Verboom L, Smeenk FW, van den Borne BE, et al. Progression of osteoporosis in patients with COPD: a 3-year follow up study. Respir Med, 2012, 106(6): 861-870.
14.	Maurel DB, Boisseau N, Benhamou CL, et al. Alcohol and bone: review of dose effects and mechanisms. Osteoporos Int, 2012, 23(1): 1-16.
15.	Luo Z, Liu Y, Liu Y, et al. Cellular and molecular mechanisms of alcohol-induced osteopenia. Cell Mol Life Sci, 2017, 74(24): 4443-4453.
16.	Liu WT, Kuo HP, Liao TH, et al. Low bone mineral density in COPD patients with osteoporosis is related to low daily physical activity and high COPD assessment test scores. Int J Chron Obstruct Pulmon Dis, 2015, 10: 1737-1744.
17.	Katzman WB, Huang MH, Lane NE, et al. Kyphosis and decline in physical function over 15 years in older community-dwelling women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci, 2013, 68(8): 976-983.
18.	Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine (Phila Pa 1976), 1999, 24(17): 1772-1776.
19.	Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med, 1988, 319(26): 1701-1707.
20.	Deng D, Lian Z, Cui W, et al. Function of low back muscle exercise: Preventive effect of refracture analysis of postoperative vertebral fractures. Orthopade, 2019, 48(4): 337-342.
21.	Yang S, Liu Y, Yang H, et al. Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty. Int J Surg, 2016, 36(Pt A): 138-142.
22.	Yang YS, Tsou YS, Lo WC, et al. Teriparatide associated with fewer refractures and higher body heights of cemented vertebrae after vertebroplasty: A matched cohort study. Sci Rep, 2020, 10(1): 6005.
23.	Röder C, Boszczyk B, Perler G, et al. Cement volume is the most important modifiable predictor for pain relief in BKP: results from SWISSspine, a nationwide registry. Eur Spine J, 2013, 22(10): 2241-2248.
24.	Nagaraja S, Awada HK, Dreher ML, et al. Effects of vertebroplasty on endplate subsidence in elderly female spines. J Neurosurg Spine, 2015, 22(3): 273-282.
25.	毛克亚, 刘建恒, 王旭翾. 椎体增强术后继发骨折的研究进展. 解放军医学院学报, 2019, 40(6): 596-599, 604.
26.	Han S, Jang IT. Analysis of adjacent fractures after two-level percutaneous vertebroplasty: Is the intervening vertebral body prone to re-fracture? Asian Spine J, 2018, 12(3): 524-532.
27.	杨俊松, 陈浩, 刘鹏, 等. 椎体成形术后早期腰背部残余疼痛的原因分析. 中华骨科杂志, 2020, 40(10): 625-634.
28.	杨俊松, 陈浩, 郝定均, 等. 经皮椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折疗效不佳的多因素分析. 中国脊柱脊髓杂志, 2020, 30(1): 45-52.
29.	Guan H, Yang H, Mei X, et al. Early or delayed operation, which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty. Injury, 2012, 43(10): 1698-1703.
30.	许正伟, 贺宝荣, 郝定均, 等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展. 中华骨科杂志, 2016, 36(17): 1142-1148.
31.	König MA, Panzer S, Schulz J, et al. Magnetic resonance imaging changes of intervertebral discs after kyphoplasty. Eur Spine J, 2015, 24(4): 724-733.

1. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol, 2017, 5(7): 513-523.
2. Yang H, Chen L, Zheng Z, et al. Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study. J Orthop Translat, 2017, 11: 73-77.
3. Feng L, Feng C, Chen J, et al. The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord, 2018, 19(1): 195.
4. Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26): B19-26.
5. Oliveira PP, Marinheiro LP, Wender MC, et al. Prevalence of vertebral fractures and risk factors in women over 60 years of age in Chapecó, Santa Catarina State, Brazil. Cad Saude Publica, 2010, 26(9): 1777-1787.
6. Warden SJ, Carballido-Gamio J, Avin KG, et al. Adaptation of the proximal humerus to physical activity: A within-subject controlled study in baseball players. Bone, 2019, 121: 107-115.
7. Eichler MC, Spross C, Ewers A, et al. Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience. J Neurosurg Spine, 2016, 25(4): 528-534.
8. Iki M. Osteoporosis and smoking. Clin Calcium, 2005, 15(7): 156-158.
9. Wong PK, Christie JJ, Wark JD. The effects of smoking on bone health. Clin Sci (Lond), 2007, 113(5): 233-241.
10. Kim KH, Lee CM, Park SM, et al. Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey. Osteoporos Int, 2013, 24(2): 523-532.
11. Leib ES, Saag KG, Adachi JD, et al. Official positions for FRAX(^®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(^®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(^®). J Clin Densitom, 2011, 14(3): 212-219.
12. Hubbard R, Tattersfield A, Smith C, et al. Use of inhaled corticosteroids and the risk of fracture. Chest, 2006, 130(4): 1082-1088.
13. Graat-Verboom L, Smeenk FW, van den Borne BE, et al. Progression of osteoporosis in patients with COPD: a 3-year follow up study. Respir Med, 2012, 106(6): 861-870.
14. Maurel DB, Boisseau N, Benhamou CL, et al. Alcohol and bone: review of dose effects and mechanisms. Osteoporos Int, 2012, 23(1): 1-16.
15. Luo Z, Liu Y, Liu Y, et al. Cellular and molecular mechanisms of alcohol-induced osteopenia. Cell Mol Life Sci, 2017, 74(24): 4443-4453.
16. Liu WT, Kuo HP, Liao TH, et al. Low bone mineral density in COPD patients with osteoporosis is related to low daily physical activity and high COPD assessment test scores. Int J Chron Obstruct Pulmon Dis, 2015, 10: 1737-1744.
17. Katzman WB, Huang MH, Lane NE, et al. Kyphosis and decline in physical function over 15 years in older community-dwelling women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci, 2013, 68(8): 976-983.
18. Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine (Phila Pa 1976), 1999, 24(17): 1772-1776.
19. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med, 1988, 319(26): 1701-1707.
20. Deng D, Lian Z, Cui W, et al. Function of low back muscle exercise: Preventive effect of refracture analysis of postoperative vertebral fractures. Orthopade, 2019, 48(4): 337-342.
21. Yang S, Liu Y, Yang H, et al. Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty. Int J Surg, 2016, 36(Pt A): 138-142.
22. Yang YS, Tsou YS, Lo WC, et al. Teriparatide associated with fewer refractures and higher body heights of cemented vertebrae after vertebroplasty: A matched cohort study. Sci Rep, 2020, 10(1): 6005.
23. Röder C, Boszczyk B, Perler G, et al. Cement volume is the most important modifiable predictor for pain relief in BKP: results from SWISSspine, a nationwide registry. Eur Spine J, 2013, 22(10): 2241-2248.
24. Nagaraja S, Awada HK, Dreher ML, et al. Effects of vertebroplasty on endplate subsidence in elderly female spines. J Neurosurg Spine, 2015, 22(3): 273-282.
25. 毛克亚, 刘建恒, 王旭翾. 椎体增强术后继发骨折的研究进展. 解放军医学院学报, 2019, 40(6): 596-599, 604.
26. Han S, Jang IT. Analysis of adjacent fractures after two-level percutaneous vertebroplasty: Is the intervening vertebral body prone to re-fracture? Asian Spine J, 2018, 12(3): 524-532.
27. 杨俊松, 陈浩, 刘鹏, 等. 椎体成形术后早期腰背部残余疼痛的原因分析. 中华骨科杂志, 2020, 40(10): 625-634.
28. 杨俊松, 陈浩, 郝定均, 等. 经皮椎体成形术治疗胸腰椎骨质疏松性椎体压缩骨折疗效不佳的多因素分析. 中国脊柱脊髓杂志, 2020, 30(1): 45-52.
29. Guan H, Yang H, Mei X, et al. Early or delayed operation, which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty. Injury, 2012, 43(10): 1698-1703.
30. 许正伟, 贺宝荣, 郝定均, 等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展. 中华骨科杂志, 2016, 36(17): 1142-1148.
31. König MA, Panzer S, Schulz J, et al. Magnetic resonance imaging changes of intervertebral discs after kyphoplasty. Eur Spine J, 2015, 24(4): 724-733.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors analysis of adjacent fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

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