Does spinal sagittal imbalance lead to future vertebral compression fractures in osteoporosis patients?

Many risk factors for osteoporotic vertebral compression fractures (OVCFs) have been reported. However, there are few reports on the relationship between spine sagittal parameters in patients with osteoporosis.

To explore whether: spinal sagittal imbalance is associated with future vertebral compression fractures in osteoporosis patients; spinal sagittal parameters in patients with osteoporosis can predict the occurrence of vertebral compression fractures.

A retrospective cohort study.

Patients with osteoporosis.

Occurrence of OVCFs during the follow-up period.

From January 2017 to October 2019, eligible patients with osteoporosis at the initial visit were enrolled. They were followed up to November 1, 2020. Based on whether OVCFs occurred during the follow-up, the patients were divided into two groups: the experimental group (vertebral compression fracture group) and the control group (no vertebral compression fracture group). Intragroup analysis was performed as follows: Pearson and Spearman correlation coefficients were used to calculate the correlation between each parameter. Intergroup analysis was performed as follows. For categorical variables, the chi-square test was used; for normally distributed continuous variables, an independent sample t-test was used; and for non-normally distributed variables, a two-sample nonparametric test was used. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine independent risk factors and critical values, respectively.

A total of 340 patients with osteoporosis were enrolled. The longest and shortest follow-up periods were 44 months and 12 months, respectively, with an average of 25.2±10.2 months. There were significant differences in age, bone mineral density (femur and lumbar), smoking history, medication treatment regularity, Thoracolumbar Kyphosis (TLK), Pelvic Tilt (PT), C7-S1 Sagittal Vertical Axis (C7-S1 SVA), and C2-7 Sagittal Vertical Axis (C2-7 SVA) between the experimental and control groups. There were no significant differences in sex, body mass index (BMI), alcohol consumption history, hypertension, diabetes, coronary heart disease, family history of osteoporosis, physical activity, Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Incidence (PI), Sacral Slope (SS), C2-C7 Cobb Angle (CL), T1 slope (T1S) or blood parameters. Through binary logistic regression analysis, we found that BMD, medication treatment regularity and C7-S1 SVA were independent risk factors for future vertebral compression fractures. According to the ROC curve, the prediction accuracy of C7-S1 SVA was the highest. Through the calculation of critical values, we found that when C7-S1 SVA was more than 3.81 cm, future OVCFs were more likely to occur, and for every 1cm increase in C7-S1 SVA, the incidence of future OVCFs would increase by 0.324 times (p<.001, OR=1.324). Through intragroup analysis, we further found that C7-S1 SVA was positively correlated with the percentage of vertebral body wedging.

For patients with osteoporosis, a C7-S1 SVA more than 3.81cm is significantly associated with a greater risk for vertebral compression fractures in the future.