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Impact of Initial Conservative Treatment Interventions on the Outcomes of Patients With Osteoporotic Vertebral Fractures

Hoshino, Masatoshi MD, PhD*; Tsujio, Tadao MD, PhD*; Terai, Hidetomi MD, PhD; Namikawa, Takashi MD, PhD; Kato, Minori MD, PhD; Matsumura, Akira MD, PhD; Suzuki, Akinobu MD, PhD; Takayama, Kazushi MD, PhD; Takaoka, Kunio MD, PhD*; Nakamura, Hiroaki MD, PhD

doi: 10.1097/BRS.0b013e31828ced9d
Clinical Case Series

Study Design. Prospective multicenter study.

Objective. To examine whether initial conservative treatment interventions for osteoporotic vertebral fractures (OVF) influence patient outcomes.

Summary of Background Data. OVFs have been described as stable spinal injuries and, in most cases, are managed well with conservative treatment. However, systematic treatments for OVF have not been clearly established.

Methods. A total of 362 patients with OVF (59 males and 303 females; mean age, 76.3 yr) from 25 institutes were enrolled in this clinical study. All the patients were treated conservatively without any surgical interventions. The patient outcomes were evaluated 6 months after the fractures on the basis of Short Form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS), activities of daily living (the Japanese long-term care insurance system), back pain (visual analogue scale), cognitive status (mini-mental state examination), and vertebral collapse, which were used as response variables. Furthermore, brace type, hospitalization, bisphosphonates after injury, and painkillers after injury were explanatory variables for the treatment interventions. To evaluate the independent effects of treatment interventions on patient outcomes, we performed multivariate logistic regression analyses and obtained odds ratios that were adjusted for the potential confounding effects of age, sex, level of fracture, presence of middle-column injury, pain visual analogue scale at enrollment, mini-mental state examination score at enrollment, and previous use of steroids.

Results. There was no significant difference for treatment intervention factors including brace type, hospitalization, bisphosphonates after injury, and painkillers after injury. For adjusting factors, the presence of middle-column injury was significantly associated with SF-36 PCS ≤ 40, reduced activities of daily living, prolonged back pain, and vertebral collapse. Female sex and advanced age were associated with SF-36 PCS ≤ 40. Low mini-mental state examination scores at enrollment were associated with SF-36 PCS ≤ 40 and reduced activities of daily living. The previous use of steroids was associated with SF-36 MCS ≤ 40, prolonged back pain, and vertebral collapse. No other examined variables were significant risk factors for patient outcomes.

Conclusion. These results showed that treatment intervention factors did not affect patient outcomes 6 months after OVF. Middle-column injury was a significant risk factor for both clinical and radiological outcomes. In the future, establishing systematic treatments for cases with middle-column injuries is needed.

Level of Evidence: 2

We investigated whether initial conservative treatment interventions for osteoporotic vertebral fracture (OVF) influence patient outcomes, including Short Form-36 (SF-36) physical component summary 40 or less, SF-36 mental component summary 40 or less, reduced activities of daily living, prolonged back pain, cognitive impairment, and vertebral collapse. The treatment intervention factors did not affect the patient outcomes 6 months after OVF. Middle-column injury was a significant risk factor for both clinical and radiological outcomes.

*Spine Center, Shiraniwa Hospital, Nara, Japan; and

Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

Address correspondence and reprint requests to Masatoshi Hoshino, MD, PhD, Spine Center, Shiraniwa Hospital, 6-10-1 Shiraniwadai, Ikoma, Nara 630-0136, Japan; E-mail: hirotoy@msic.med.osaka-cu.ac.jp

Acknowledgment date: July 6, 2012. First revision date: September 6, 2012. Second revision date: December 11, 2012. Third revision date: January 22, 2013. Acceptance date: January 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Health and Labour Sciences Research Grants for Comprehensive Research on Aging and Health, Japan, funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2013 by Lippincott Williams & Wilkins