Incidence of concomitant and previous osteoporotic vertebral fractures

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Incidence of concomitant and previous osteoporotic vertebral fractures

Numerous fractures on plain radiographs are observed in patients suffering from osteoporosis who present with an acute onset of back pain. It is, however arduous to differentiate an acute osteoporotic vertebral fracture (AOVF) from previous fractures. The objective of the study mentioned here was to examine the prevalence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to recognize risk factors for concomitant AOVFs.

To achieve this 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006 were taken up from the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA). This was a prospective epidemiological study in which the concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that occur concomitantly. A prior fracture is a STIR-negative fracture at the time of initial diagnostics. To investigate the influence of various variables on the incidence of concomitant fractures, logistic regression was used.

More than 99% of osteoporotic vertebral fractures were found to be eventuated in the thoracic and lumbar spine. Prevalence of concomitant fractures at the time of first patient contact was 26% and that of prior fractures was 60%. The odds ratio (OR) for concomitant fractures declined with a higher number of previous fractures (OR=0.86; p= 0.03) and higher dual-energy X-ray absorptiometry T-score (OR=0.72; p=0.003).

It could thus be interpreted that concomitant and previous osteoporotic vertebral fractures are common. As for osteoporotic vertebral fracture, the risk factors for concomitant fractures is a low T-score (T-score = (patient BMD – young normal mean BMD) / standard deviation of the young normal population.)and a low number of previous vertebral fractures. A lower T score increases the risk of concomitant fractures and a higher T score reduces the risk of fractures. To prevent/reduce the risk of under-diagnosis and under-treatment, an MRI scan of the complete thoracic and lumbar spine with STIR sequence needs to be performed.


Acta Orthopedicia

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The original title of the article:

Concomitant and previous osteoporotic vertebral fractures


Markus Lenski et al.

Exploratory, Acute, Osteoporotic vertebral fractures, Prospective epidemiological study, BMD
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