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Incidence and cause of incident vertebral compression fractures (VCF) in patients following vertebral augmentation 2011

Interventional Spine

Orlando, Ortiz, MD, MBA
Amanjit, Baadh, MD, Non ASSR Member
Ritu, Bordia, MBBS, Non ASSR Member

Paper/Non-Mentor

Purpose

To determine the incidence and causative factors of a subsequent VCF in patients who have had previous vertebral augmentation for their osteoporotic VCF.

Methods & Materials

Medical records were reviewed retrospectively for all patients who underwent vertebral augmentation procedures for treatment of VCFs from October 2000 to April 2009. Patients who sustained a repeat VCF after initial fracture and treatment with vertebral augmentation were identified and the underlying cause or associated factor involved in the incident fracture noted. Underlying causes and associated factors were identified as trauma or fall, no osteoporosis treatment or failed treatment compliance, no post procedure physical therapy, failure to follow safe movement guidelines, steroid dependent osteoporosis, underlying multiple myeloma and no cause found.

Results

Out of the 439 patients included in this study, 346 were female and 93 were male. The mean age of these patients was 76.9 years (age range - 25 to 95 years). We found that 59 (13.4%) of these patients suffered a repeat VCF after their initial fracture had been treated with vertebral augmentation. As some patients suffered multiple repeat fractures the total number of repeat fractures recorded was 79. Of these 79 repeat VCFs, 21 were due trauma/fall, 14 were associated with absence of osteoporosis treatment or lack of treatment compliance, 4 did not undergo post procedure physical therapy, 13 fractures were associated with a failure to follow safe movement guidelines, 8 incident fractures occurred in patients with steroid dependent osteoporoses, 2 fractures occurred in patients with a diagnosis of multiple myeloma and no underlying cause or association was found in 17 fractures. Of these 79 repeat fractures 42 (53.2%) occurred adjacent to vertebral levels previously augmented/treated. Out of the 79 repeat fractures identified 36 (45.6%) occurred within one year of previous fracture and 53 (67.1%) occurred within 2 years.

Conclusion

Patients who have experienced an osteoporotic VCF are at high risk for experiencing a repeat fracture. Fracture risk remains high unless these patients are diligently managed following their vertebral augmentation procedure. The relatively short time frame from initial fracture to repeat fracture identified favors early identification and aggressive management of underlying risk factors.

References/Financial Disclosures

1.Rad AE, Gray LA, Kallmes DF. Incident vertebral fractures in patients not undergoing vertebroplasty. J Vasc Interv Radiol 2010;21:856-860 2. Hiwatashi A, Yoshiura T, Yamashita K, et al. Subsequent fracture after percutaneous vertebroplasty can be predicted multidetector row CT. AJNR Am J Neuroradiol 2009;30:1830-1834 3. Lee WS, Sung KH, Jeong HT, et al. Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J 2006;15:1777-1783 4. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 2006;27:217-223 Financial Disclosures: Dr. Ortiz â