원발성 골다공증 척추 골절 치료 후에 속발된 골절의 잠재적 위험인자 = Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures

다국어 초록 (Multilingual Abstract)

Study Design: A retrospective study.
Objectives: To investigate the potential risk factors for subsequent vertebral fractures according to the treatment of primary vertebral fractures.
Summary of Literature Review: Many previous studies have been reported on bone mineral density, bone loss, and mechanical properties as risk factors for osteoporotic vertebral fractures. However, few studies have investigated subsequent osteoporotic vertebral fractures.
Materials and Methods: 57 patients who had undergone follow-up magnetic resonance imaging (MRI) of the spine were divided into two groups depending on the development of subsequent vertebral fractures: the fracture group with 40 cases and the non-fracture group with 17 cases. The patients’ clinical and radiographic data including bone mineral density, medication for osteoporosis, body mass index, vertebroplasty of primary vertebral fractures, thoracic kyphotic angle and lumbar lordotic angle, fat infiltration of the back extensor muscle, and primary multiple fractures were examined.
Results: The subsequent new vertebral fractures occurred at a mean of 24 ± 19 months after primary osteoporotic vertebral fractures.
Vertebroplasty for primary fractures was associated with a higher incidence of subsequent new vertebral fractures (p=0.001). There was a significant increase in fat infiltration of the back extensor muscle after the primary vertebral fractures in the fracture group (p=0.001). A multiple logistic regression analysis showed the significance of vertebroplasty (odds’ ratio: 4.623, 95% confidence interval: 1.145–18.699, p=0.031).
Conclusions: These results suggest that vertebroplasty for primary vertebral fractures and increased fat infiltration of the back extensor muscle could be risk factors related to the development of subsequent osteoporotic vertebral fractures.

국문 초록 (Abstract)

연구 계획: 후향적 연구적: 골다공증성 척추 골절 치료에 따라 속발된 인접 부위 척추골절에 대한 잠재적 위험인자에 대하여 조사하고자 하였다.
선행 문헌의 요약: 기존의 연구들에서 골밀도 및 골소실, 척추 주위 근육 등 일차 골다공증성 척추 골절 위험인자 연구가 보고되었으나 속발된 인접부위척추골절에 대한 연구는 아직 부족하다.
대상 및 방법: 골다공증성 척추 골절이 있었던 환자들 중 골절 이후 추적 자기 공명 영상 검사를 시행한 57명의 환자들을 대상으로 인접 부위 척추골절이 발생한 40명과 발생하지 않은 17명을 두 군으로 나누어 연구를 진행하였다. 흉추 후만각, 요추 전만각, 요추 신전근의 지방 침윤 등 환자들의 방사선학적 요인들과 골밀도 수치, 체질량 지수, 골다공증 치료 약제 복용력, 척추 성형술 기왕력 등 전신 인자 및 임상적 요인들에 대하여 조사하였다.
결과: 인접 분절 척추골절은 선행한 골다공증성 척추 골절후 평균 24±19 개월 후에 발생하였다. 선행한 골절을 척추 성형술로 치료한 경우에 인접 부위 척추골절의 발생률이 유의하게 증가하였으며(p=0.001) 척추골절이 발생한 군에서 요추 신전근의 지방 침윤 정도가 골절이 발생하지 않은 군에 비하여 유의하게 증가되어있음을 확인할 수 있었다(p=0.001). 로지스틱 회귀 분석 결과에서도 척추성형술과 척추골절의 연관성이 높게 나타났다(OR 4.623, 95% CI 1.145-18.699, p=0.031).
결론: 선행한 골다공증성 척추 골절을 척추 성형술로 치료와 척추 골절 후 요추 신전근의 지방 침윤 증가는 인접 부위 척추 골절의 잠재적 위험인자의하나로 고려될 수 있다.

참고문헌 (Reference)

• 1 Sanfelix-Genoves J, "The population-based prevalence of osteoporotic vertebral fracture and densitometric osteoporosis in postmenopausal women over 50 in Valencia, Spain (the FRAVO study)" 47 : 610-616, 2010
• 2 So KY, "The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures" 7 : 308-313, 2013
• 3 문은수, "The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved" 연세대학교의과대학 48 (48): 645-652, 2007
• 4 Sinaki M, "Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women" 30 : 836-841, 2002
• 5 Lindsay R, "Risk of new vertebral fracture in the year following a fracture" 285 : 320-323, 2001
• 6 Kim SH, "Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty" 45 : 440-445, 2004
• 7 Lee WS, "Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients" 15 : 1777-1783, 2006
• 8 Ma X, "Risk factors for new vertebral compression fractures after percutaneous vertebroplasty" 38 : E713-E722, 2013
• 9 Zhang Z, "Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty:a systematic review and meta-analysis" 26 : E150-E157, 2013
• 10 Lee JC, "Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls" 33 : 318-325, 2008
• 11 Cunha-Henriques S, "Postmenopausal women with osteoporosis and musculoskeletal status: a comparative cross-sectional study" 3 : 168-176, 2011
• 12 Klotzbuecher CM, "Patients with prior fractures have an increased risk of future fractures:a summary of the literature and statistical synthesis" 15 : 721-739, 2000
• 13 Yuan HA, "Osteoporotic spinal deformity: a biomechanical rationale for the clinical consequences and treatment of vertebral body compression fractures" 17 : 236-242, 2004
• 14 Lin WC, "New vertebral osteoporotic compression fractures after percutaneous vertebroplasty:retrospective analysis of risk factors" 19 : 225-231, 2008
• 15 Syed MI, "New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women" 26 : 1601-1604, 2005
• 16 Melton LJ, 3rd, "Epidemiology worldwide" 32 : 1-13, 2003
• 17 Nevitt MC, "Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group" 160 : 77-85, 2000
• 18 Sinaki M, "Can strong back extensors prevent vertebral fractures in women with osteoporosis?" 71 : 951-956, 1996
• 19 Myers ER, "Biomechanics of osteoporosis and vertebral fracture" 22 (22): 25S-31S, 1997
• 20 Hayes WC, "Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography" 29 : 1-18, 1991
• 21 Hayes WC, "Biomechanical considerations of hip and spine fractures in osteoporotic bone" 46 : 431-438, 1997
• 22 Johnell O, "An estimate of the worldwide prevalence and disability associated with osteoporotic fractures" 17 : 1726-1733, 2006
• 23 Berlemann U, "Adjacent vertebral failure after vertebroplasty. A biomechanical investigation" 84 : 748-752, 2002
• 24 Briggs AM, "A review of anatomical and mechanical factors affecting vertebral body integrity" 1 : 170-180, 2004