Concomitant and previous osteoporotic vertebral fractures.

Area of Science:

• Orthopedics
• Radiology
• Epidemiology

Background:

• Osteoporotic vertebral fractures often present as acute back pain.
• Differentiating acute osteoporotic vertebral fractures (AOVFs) from prior fractures is clinically difficult.
• Plain radiographs may not adequately distinguish between acute and old fractures.

Purpose of the Study:

• To determine the incidence of concomitant AOVFs and previous osteoporotic vertebral fractures (OVFs).
• To identify risk factors associated with concomitant AOVFs.
• To emphasize the diagnostic value of advanced imaging in managing vertebral fractures.

Main Methods:

• Prospective epidemiological study using the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA).
• Inclusion of 1,005 patients and 2,874 OVFs.
• Definition of concomitant fractures as ≥2 acute STIR-positive vertebral fractures; previous fractures as STIR-negative.
• Logistic regression analysis to identify risk factors.

Main Results:

• Over 99% of OVFs occurred in the thoracic and lumbar spine.
• The incidence of concomitant fractures was 26%, and previous fractures was 60% at initial presentation.
• Lower T-scores (OR=0.72) and fewer previous fractures (OR=0.86) were associated with increased risk of concomitant fractures.

Conclusions:

• Concomitant and previous osteoporotic vertebral fractures are highly prevalent.
• Low bone density (low T-score) and a history of fewer prior fractures are risk factors for concomitant fractures.
• Thoracic and lumbar spine MRI with STIR sequences is crucial for accurate diagnosis and treatment of AOVFs.