1
|
Advanced Sampling Technique in Radiology Free-Text Data for Efficiently Building Text Mining Models by Deep Learning in Vertebral Fracture. Diagnostics (Basel) 2024; 14:137. [PMID: 38248014 PMCID: PMC10814913 DOI: 10.3390/diagnostics14020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
This study aims to establish advanced sampling methods in free-text data for efficiently building semantic text mining models using deep learning, such as identifying vertebral compression fracture (VCF) in radiology reports. We enrolled a total of 27,401 radiology free-text reports of X-ray examinations of the spine. The predictive effects were compared between text mining models built using supervised long short-term memory networks, independently derived by four sampling methods: vector sum minimization, vector sum maximization, stratified, and simple random sampling, using four fixed percentages. The drawn samples were applied to the training set, and the remaining samples were used to validate each group using different sampling methods and ratios. The predictive accuracy was measured using the area under the receiver operating characteristics (AUROC) to identify VCF. At the sampling ratios of 1/10, 1/20, 1/30, and 1/40, the highest AUROC was revealed in the sampling methods of vector sum minimization as confidence intervals of 0.981 (95%CIs: 0.980-0.983)/0.963 (95%CIs: 0.961-0.965)/0.907 (95%CIs: 0.904-0.911)/0.895 (95%CIs: 0.891-0.899), respectively. The lowest AUROC was demonstrated in the vector sum maximization. This study proposes an advanced sampling method, vector sum minimization, in free-text data that can be efficiently applied to build the text mining models by smartly drawing a small amount of critical representative samples.
Collapse
|
2
|
Computer Vision in Osteoporotic Vertebral Fracture Risk Prediction: A Systematic Review. Neurospine 2023; 20:1112-1123. [PMID: 38171281 PMCID: PMC10762393 DOI: 10.14245/ns.2347022.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Osteoporotic vertebral fractures (OVFs) are a significant health concern linked to increased morbidity, mortality, and diminished quality of life. Traditional OVF risk assessment tools like bone mineral density (BMD) only capture a fraction of the risk profile. Artificial intelligence, specifically computer vision, has revolutionized other fields of medicine through analysis of videos, histopathology slides and radiological scans. In this review, we provide an overview of computer vision algorithms and current computer vision models used in predicting OVF risk. We highlight the clinical applications, future directions and limitations of computer vision in OVF risk prediction.
Collapse
|
3
|
Bracing and taping interventions for individuals with vertebral fragility fractures: a systematic review of randomized controlled trials with GRADE assessment. Arch Osteoporos 2023; 18:36. [PMID: 36840787 DOI: 10.1007/s11657-023-01224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
This systematic review analyzes the effects of bracing and taping after osteoporotic vertebral fractures. Spinal orthose may have positive effects on pain, but the evidence is of very low certainty. Clinical judgment is recommended when prescribing spinal orthoses. PURPOSE To examine the effects of bracing and taping interventions on pain, physical functioning, health-related quality of life, back extensor strength, kyphosis curvature, and adverse events in individuals with vertebral fragility fractures. METHODS Four databases were searched from inception up to January 2022. We included randomized controlled trials testing the effect of bracing or taping interventions compared with a non-intervention control in adults ≥ 45 years with vertebral fragility fractures. Narrative syntheses were presented for all the outcomes. We assessed the risk of bias using the Cochrane Risk of Bias Assessment Tool and the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS Three studies were included. Soft bracing interventions exhibited inconsistent effects on pain. One study showed no difference between groups, and another study should a decrease in pain in the soft bracing group compared to the control group. Rigid bracing interventions did not have a significant change in pain between the control and intervention groups. One study demonstrated a decrease in pain at rest (VAS: - 10.8 ± 19.3) and during movement (VAS: - 20.9 ± 29.8) after a taping intervention. The other outcomes were not consistent across studies. CONCLUSIONS Spinal orthoses may improve pain in people with vertebral fractures; however, we cannot draw definitive conclusions on the efficacy or harms of bracing or taping due to the very low certainty evidence and the small number of studies. Effects on other outcomes are uncertain.
Collapse
|
4
|
Effect of a new transpedicular vertebral device for the treatment or prevention of vertebral compression fractures: A finite element study. Clin Biomech (Bristol, Avon) 2023; 102:105893. [PMID: 36682151 DOI: 10.1016/j.clinbiomech.2023.105893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND A finite element study was performed to investigate the biomechanical performance of a novel transpedicular implant (V-STRUT©, Hyprevention, France) made of PEEK (polyetheretherketone) material in terms of strengthening the osteoporotic vertebra and the thoraco-lumbar spine. The objective was to assess numerically the efficacy of the implant to reduce the stress distribution within bone and absorb part of the stress by the implant thanks to its optimized material selection close to that of normal bone. METHODS A numerical model was generated based on a scan of an osteoporotic patient. The model is composed of three consecutive vertebrae and intervertebral discs. A heterogeneous distribution of bone material properties was assigned to the bone. In order to investigate the rationale of the device material selection, three FE models were developed (i) without the device to serve a reference model, (ii) with device made in Titanium material and (iii) with device made in PEEK material. Stiffness and stress distribution within the spine segment were computed and compared in order to assess the implants' performances. FINDINGS The results obtained by the simulations indicated that the novel transpedicular implant made of PEEK material provided support to the superior vertebral endplate, restored the thoraco-lumbar spine segment stiffness and reduced the stress applied to the vertebrae under the compressive load. INTERPRETATION Implant geometry in combination with its material properties are very important factors to restore vertebral strength and stiffness and limiting the risk of fracture at the same vertebra or adjacent ones.
Collapse
|
5
|
Difference in the Cobbs Angle Between Standing and Supine Position as a Prognostic Factor After Vertebral Augmentation in Osteoporotic Vertebral Compression Fractures. Neurospine 2022; 19:357-366. [PMID: 35588761 PMCID: PMC9260559 DOI: 10.14245/ns.2143172.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We retrospectively analyzed patients with osteoporotic vertebral compression fracture (OVCF) undergoing vertebral augmentation to compare the Cobb angle changes in the supine and standing positions and the clinical outcomes.
Methods We retrospectively extracted the data of OVCF patients who underwent vertebral augmentation. Back pain was assessed using a visual analogue scale (VAS). Supine and standing radiographs were assessed before treatment to determine the Cobb angle and compression ratio. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff to predict favorable outcomes after vertebral augmentation.
Results A total of 249 patients were included. We observed a statistically significant increase in the VAS score change with increasing Cobb angle and compression ratio (p < 0.001), and multivariate logistic regression analysis showed that a difference in the Cobb angle (odds ratio [OR], 1.27) and compression ratio (OR, 1.12) were the independent risk factors for predicting short-term favorable outcomes after vertebral augmentation. In addition, we found that the difference in the Cobb angle (OR, 1.05) was the only factor for predicting midterm favorable outcomes after vertebral augmentation. The optimal cutoff value of the difference in the Cobb angle for predicting midterm favorable outcomes was 35.526°.
Conclusion We found that the midterm clinical outcome after vertebral augmentation was better when there was a difference of approximately 35% or more in the Cobb angle between the standing and supine positions. Surgeons should pay attention to the difference in the Cobb angle depending on the posture when deciding to perform vertebral augmentation in patients with OVCFs.
Collapse
|
6
|
Etiologies, incidence, and demographics of lumbar vertebral fractures in U.S. emergency departments. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:21-28. [PMID: 35441096 DOI: 10.21037/jss-21-110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
Background Lumbar vertebral fractures are debilitating injuries widely associated with significant patient deformity, disability, pain, and potentially neurological deficit. This cross-sectional database study investigates the most frequent annual etiologies of lumbar vertebral fractures presented to emergency departments throughout the United States (U.S.) from 2010-2018. Methods The National Electronic Injury Surveillance System (NEISS) database was used to identify all patients who visited participating emergency departments between 2010-2018 and were diagnosed with a lumbar spine fracture. Population estimates by age (18+) were obtained from annual U.S. Census estimates and used to calculate annual incidence rates of lumbar fractures per 100,000 people. Results The annual incidence rate of total lumbar fractures in the U.S. increased from 14.6 to 22.5 per 100,000 people from 2010-2018 (54%). From 2010-2018, there were 382,914 [95% confidence interval (CI): 382,855-382,973] lumbar fractures in the U.S. This increased from 34,328 (95% CI: 34,277-34,379) in 2010 to 57,098 (95% CI: 57,044-57,152) in 2018 (66.3%). Men composed 40.2% and women made up 59.8% of patients. Mean patient age increased by 2.96 years from 65.5 (95% CI: 65.38-65.62) years in 2010 to 68.4 (95% CI: 68.32-68.48) years in 2018 (4.5%). From 2010-2018, floors, stairs/steps, and ladders were the most common etiologies of lumbar fractures. Estimated sum of floor-related fractures was 80,054 (95% CI: 79,986-80,122), stair/step-related fractures was 48,274 (95% CI: 48,209-48,339), and ladder-related fractures was 31,053 (95% CI: 30,987-31,119). The increase in these three etiologies accounted for 48% of the total increase of all-cause lumbar fractures between 2010 and 2018. Conclusions The volume of lumbar vertebral fracture has increased over the last near decade (66.3%), and approximately half (48%) of these fractures can be attributed to accidents caused by flooring, stairs/steps, and ladder-related injuries. The increasing mean patient age, as well as accidents involving ladders, were found to be statistically correlated with the rise in total lumbar fracture volume.
Collapse
|
7
|
Romosozumab reduces incidence of new vertebral fractures across severity grades among postmenopausal women with osteoporosis. Bone 2022; 154:116209. [PMID: 34547521 DOI: 10.1016/j.bone.2021.116209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Vertebral fractures (VFs) are the most common type of osteoporotic fracture, and their prevalence and severity are key risk factors for future fragility fractures. Here, we assess the treatment effect of romosozumab on the incidence of new on-study VFs according to Genant severity grades (mild, moderate, and severe). Data are reported from two phase 3 clinical studies for patients who received romosozumab versus placebo through 12 months, followed by denosumab through 24 months (FRAME: NCT01575834), and for patients who received romosozumab through 12 months, followed by alendronate through 24 months, versus alendronate only through 24 months (ARCH: NCT01631214). The treatment effect of romosozumab is reported for all included patients, and for patients with prevalent and severe baseline VFs. The incidence of new moderate-or-severe VFs was reduced through 12 months for patients treated with romosozumab versus placebo (FRAME; 0.25% versus 1.42%, respectively; p < 0.001) or alendronate (ARCH; 2.78% versus 4.00%, respectively; p = 0.042). Furthermore, the treatment effect of romosozumab on the incidence of new VFs across moderate and severe severity grades was independent of baseline VF prevalence or severity; through 12 months, consistent reductions in new moderate-or-severe VFs were observed regardless of prevalent (FRAME; p = 0.18) or severe (ARCH; p = 0.52) VFs at baseline. Reductions in the incidence of new moderate and severe VFs were sustained through 24 months, after transition from romosozumab to denosumab or alendronate, independent of baseline VF prevalence or severity; no significant interactions were observed between the incidence of new moderate-or-severe VFs and the presence of prevalent (FRAME; p = 0.81) or severe (ARCH; p = 0.99) VFs at baseline. With increasing recommendations for initial treatment with bone-forming agents for postmenopausal women with osteoporosis, these analyses will help to inform treatment decisions for patients at very high risk of VF.
Collapse
|
8
|
Diagnostic performance of dual-energy computed tomography for detection of acute spinal fractures. Skeletal Radiol 2020; 49:1589-1595. [PMID: 32382979 DOI: 10.1007/s00256-020-03450-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of dual-energy computed tomography (DECT) with the color-coded virtual non-calcium (VNC) technique for detecting acute fractures in patients after acute spine trauma, especially in an emergency clinical setting. MATERIALS AND METHODS Our retrospective study included 31 patients presented to emergency department with suspected spine trauma. All patients underwent both DECT (80 kVp and 140 kVp) and MRI. Post-processing was performed using color-coded VNC technique. Two independent radiologists visually assessed color-coded VNC images in a random order, and one of the two readers re-assessed the images in 4 weeks after the initial assessment. They were allowed to read only color-coded VNC images and asked to determine the presence of acute fracture. To determine the standard reference point, the other two experienced radiologists made consensus readings on both grayscale CT and MRI. Sensitivity, specificity, PPV, NPV, and accuracy analyses were determined. Both intra- and inter-observer agreements were also calculated. RESULTS A total of 217 vertebral bodies (65 thoracic and 152 lumbar vertebrae) were included in our study. Sensitivity was 83.3% and 76.7% for first and second readers, respectively. Specificity of 99.5% and 98.9%, PPV of 96.1% and 96.3%, NPV of 97.3% and 96.3%, and accuracy of 97.2% and 95.8%, respectively, were noted. Both intra-observer and inter-observer agreements indicated excellent agreement (κ = 0.86 and κ = 0.84, respectively). CONCLUSION In spite of the relatively low sensitivity, DECT-based detection of acute spinal fractures showed good specificity, positive predictive value, negative predictive value, accuracy, and inter-/intra-observer agreements.
Collapse
|
9
|
Vertebroplasty: For whom and when. Maturitas 2018; 118:76-77. [PMID: 30082095 DOI: 10.1016/j.maturitas.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/30/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
|
10
|
Effects of postural taping on pain, function and quality of life following osteoporotic vertebral fractures-A feasibility trial. Musculoskeletal Care 2018; 16:345-352. [PMID: 29808537 DOI: 10.1002/msc.1350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Osteoporotic vertebral fractures (OVFs) are common and present a significant burden to patients and healthcare services. Poor posture can increase vertebral pressure, pain and the risk of further fractures. The aim of the present study was to investigate the effects of postural taping on pain, function and quality of life when used in addition to usual care. METHODS A feasibility randomized, controlled trial was carried out in men and women with at least one clinically diagnosed painful OVF. Participants were randomly allocated to use an adhesive postural taping device at home for 4 weeks or to continue with usual care. Outcomes assessed at baseline and 4 weeks included pain at rest and on movement (visual analogue scales [VASs]), and function and quality of life (Quality of Life Questionnaire of the European Foundation for Osteoporosis [QUALEFFO]). Health resource use and acceptability were explored using a specifically designed questionnaire. RESULTS Twenty-four participants completed the trial (taping, n = 13; control, n = 11). Groups were comparable in age, although the control group contained more men (n = 3 versus n = 0) and scored slightly lower on most outcome measures at baseline. Descriptive analysis favoured the taping group for most outcome measures. Effect sizes were small to medium (0.37, 0.45 and 0.66 for VAS rest, VAS movement and QUALEFFO, respectively). CONCLUSIONS The taping device demonstrated potential to improve pain and function. However, the findings need to be replicated in an appropriately powered study. The study procedures were largely acceptable. A more extensive pilot trial is recommended prior to a definitive trial.
Collapse
|
11
|
Conservative management of osteoporotic vertebral fractures: an update. Eur J Trauma Emerg Surg 2016; 43:19-26. [DOI: 10.1007/s00068-016-0747-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/29/2016] [Indexed: 12/14/2022]
|
12
|
Bone mineral density at different sites and vertebral fractures in Serbian postmenopausal women. Climacteric 2016; 20:37-43. [DOI: 10.1080/13697137.2016.1253054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Abstract
Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain.
Collapse
|
14
|
Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ Open 2016; 6:e010657. [PMID: 27147384 PMCID: PMC4861088 DOI: 10.1136/bmjopen-2015-010657] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/10/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To establish the current evidence base for the use of orthotics and taping for people with osteoporotic vertebral fracture (OVF). DESIGN Systematic review of quantitative and qualitative studies. DATA SOURCES Medline, Medline-In Process, EMBASE, AMED, CINAHL, PEDro, TRIP, EThOS, ProQuest Dissertations and Theses and Cochrane (CDSR, DARE, CMR, HTA, EED) plus Cochrane Central, UK Clinical Research Network portfolio, Controlled Clinical Trials register and the Australian and New Zealand Clinical Trials register. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All study designs were considered if they reported in English and evaluated the impact of using an external support, such as a spinal brace, orthosis or postural tape, with adults with OVF. All outcomes were considered. RESULTS Nine studies were included comprising two parallel-group randomised controlled trials, four randomised cross-over trials, two before-after (single arm) studies and a parallel group observational study. No qualitative studies were identified. A wide range of outcomes assessing impairments, activities and participation were assessed but the findings were mixed. The quality of studies was limited. CONCLUSIONS The current evidence for using orthotic devices or taping for people with OVF is inconsistent and of limited quality and therefore careful consideration should be taken by clinicians before prescribing them in practice. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42015020893.
Collapse
|
15
|
Abstract
Introduction Osteoporotic vertebral fractures relate to poorer quality of life and higher long-term mortality. In a resource-poor setup, conservative management assumes great importance as primary means of treatment. We assess the clinico-pathological epidemiology of osteoporotic vertebral fractures and prospectively evaluate the effectiveness of conservative management in their treatment. Materials & Methods Thirty consecutive patients, diagnosed with osteoporotic vertebral fracture, underwent the predetermined protocol of conservative treatment (bed rest, titrated analgesia, antiosteoporosis pharmacotherapy, bracing, and supervised physical therapy) after assessment of basic demographic data and clinical examination. They were evaluated every three months for nine months, using visual analog scale (VAS) for backpain, Oswestry Disability Index (ODI), and radiological and hematological parameters. Results The mean age of the patients was 66.9 +/-7.6 years and the female: male ratio was 14:1. All (100%) women were postmenopausal and the mean time since menopause was 16.75 +/- 8.12 years. The presenting complaints were backpain (100%) and deformity (53.33%). Neurodeficit was noted in one (3.33%) patient. Higher age was correlated to greater vertebral collapse (p=0.001) and higher kyphotic angle (p=0.002). At nine months after treatment, there was a significant decrease in the VAS score (p<0.0001) and the ODI score (p<0.0001), with the final VAS score improving by 49.25% and the ODI score improving by 47.23% from the baseline. There was progressive increase in vertebral collapse (p=0.0474) with no change in kyphotic or scoliotic angles. With treatment there was a consistent increase in serum calcium (p<0.0001), phosphorous (p<0.0001), and vitamin D3 (p<0.0001) levels, and decrease in parathyroid hormone levels (p<0.0001). Conclusions A multidisciplinary conservative treatment is effective as the primary treatment for patients with osteoporotic vertebral fractures. It alleviates pain, decreases disability, reduces morbidity, and is effective in preventing further progression of the disease process clinically, radiologically, and hematologically.
Collapse
|
16
|
Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe: a meta-analysis of randomized controlled trials. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:715-23. [PMID: 25399304 DOI: 10.1007/s00586-014-3581-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/06/2014] [Accepted: 09/07/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE The study aims to evaluate the safety of balloon kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures in Europe. METHODS Systematic review of the literature, until September 2013, and meta-analysis of randomized controlled trials performed in Europe assessing the safety of balloon kyphoplasty in patients with symptomatic osteoporotic vertebral fractures. Outcomes sought include cement leaks, serious clinical complications and new vertebral fractures. RESULTS Six randomized controlled trials fulfilled the inclusion criteria. These studies included data on 525 treated levels in 424 patients. Cement leakages were detected in 18.3 % (95 % CI 11.6, 23.0) of fractures intervened. In about 0.5 % (95 % CI 0.1, 1.1) of fractures leakages proved to be symptomatic. Serious clinical complications were recorded in 11.5 % (95 % CI 1.1, 21.7) of patients treated with balloon kyphoplasty with several of these cases requiring intensive treatment or postoperative surgery. New vertebral fractures were detected in 20.7 % (95 % CI 0.4, 40.9) of patients treated but rates showed an upward pattern when the follow-up period increased. In 54 % of such cases, the fractures were located in regions adjacent to the treated level. CONCLUSIONS The safety profile and associated complications of balloon kyphoplasty shown in this analysis, based on the evidence provided by existing randomized controlled trials, can be of help to the practicing clinician who must contrast them with the potential benefits of the technique. These data represent an important step towards a balanced evaluation of the intervention though, a better reporting and more reliable data on long-term assessment of potential sequelae are needed.
Collapse
|
17
|
The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis. J Korean Med Sci 2014; 29:859-63. [PMID: 24932090 PMCID: PMC4055822 DOI: 10.3346/jkms.2014.29.6.859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/07/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs ≥ 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs ≥ 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.
Collapse
|
18
|
|
19
|
Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1-year double-blind RCT in postmenopausal women. J Bone Miner Res 2013; 28:2202-13. [PMID: 23585346 DOI: 10.1002/jbmr.1959] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/25/2013] [Accepted: 04/08/2013] [Indexed: 11/08/2022]
Abstract
Few year-long vitamin D supplementation trials exist that match seasonal changes. The aim of this study was to determine whether daily oral vitamin D3 at 400 IU or 1000 IU compared with placebo affects annual bone mineral density (BMD) change in postmenopausal women in a 1-year double-blind placebo controlled trial in Scotland. White women aged 60 to 70 years (n = 305) were randomized to one of two doses of vitamin D or placebo. All participants started simultaneously in January/February 2009, attending visits at bimonthly intervals with 265 (87%) women attending the final visit and an additional visit 1 month after treatment cessation. BMD (Lunar iDXA) and 1,25-dihydroxyvitamin D[1,25(OH)2 D], N-terminal propeptide of type 1 collagen [P1NP], C-terminal telopeptide of type I collagen [CTX], and fibroblast growth factor-23 [FGF23] were measured by immunoassay at the start and end of treatment. Circulating PTH, serum Ca, and total 25-hydroxyvitamin D [25(OH)D] (latter by tandem mass spectrometry) were measured at each visit. Mean BMD loss at the hip was significantly less for the 1000 IU vitamin D group (0.05% ± 1.46%) compared with the 400 IU vitamin D or placebo groups (0.57% ± 1.33% and 0.60% ± 1.67%, respectively) (p < 0.05). Mean (± SD) baseline 25(OH)D was 33.8 ± 14.6 nmol/L; comparative 25(OH)D change for the placebo, 400 IU, and 1000 IU vitamin D groups was -4.1 ± 11.5 nmol/L, +31.6 ± 19.8 nmol/L, and +42.6 ± 18.9 nmol/L, respectively. Treatment did not change markers of bone metabolism, except for a small reduction in PTH and an increase in serum calcium (latter with 1000 IU dose only). The discordance between the incremental increase in 25(OH)D between the 400 IU and 1000 IU vitamin D and effect on BMD suggests that 25(OH)D may not accurately reflect clinical outcome, nor how much vitamin D is being stored.
Collapse
|
20
|
The correlation between vertebral wedge-shaped changes in X-ray imaging at supine and standing positions and the efficacy of operative treatment of thoracolumbar spinal fracture in the elderly. Spinal Cord 2013; 51:904-8. [PMID: 24042984 DOI: 10.1038/sc.2013.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 07/22/2013] [Accepted: 08/04/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN By analyzing a large number of surgical patients, we identified the roles of wedge-shaped changes in related surgeries. OBJECTIVES To illustrate the relevance of vertebral wedge-shaped changes in X-ray imaging at supine and standing positions in patients with percutaneous kyphoplasty as well as the postoperative effect. SETTING All patient data were collected from a hospital in China. METHODS Between June 2006 and May 2010, 77 surgical patients (9 men and 68 women) with wedge-shaped compression fractures were retrospectively analyzed. Patients were divided into group A (ΔWR2.5%) and group B (ΔWR<2.5%) according to the dynamic changes in the percentage of vertebral body wedge-shaped variable ratio (WR) at supine and standing positions. The intensity of back pain in different positions pre- and postoperatively was evaluated with a visual analog pain scale (VAS). RESULTS The WRs in both standing and supine positions were significantly reduced by kyphoplasty in both groups A and B. In agreement with the improvement in WRs, the VAS was significantly decreased in three positions for patients in group A and in turning over and standing position for patients in group B. With respect to ΔWR changes, group B revealed significantly lower values compared with group A preoperatively (P<0.001), but there was no significant difference between groups A and B postoperatively and at 1-month follow-up (P=0.179 and P=0.558, respectively). CONCLUSIONS Improvement in symptoms after kyphoplasty is better in patients with wedge-shaped changes in supine and standing positions, and the efficacy of height restoration of the spine would be better in unstable vertebrae by balloon dilatation.
Collapse
|
21
|
Validity and role of vertebral fracture assessment in detecting prevalent vertebral fracture in patients with rheumatoid arthritis. Joint Bone Spine 2013; 81:149-53. [PMID: 23932727 DOI: 10.1016/j.jbspin.2013.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 07/01/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We aimed to identify the validity and the role of vertebral fracture assessment (VFA) for the diagnosis of prevalent vertebral fracture (VF) in rheumatoid arthritis (RA) patients. METHODS Total of 100 women with RA who were 50 years or older were enrolled. All participants underwent lateral imaging of the thoraco-lumbar spine by radiography and VFA. All radiographs were analyzed by two radiologists. Discrepancies between radiologists for spine radiography were resolved by consensus and these results were defined as the reference standard. VFA interpretation was done independently by two nuclear medicine physicians. Fracture defined by VFA measure was done only when two physicians both independently reported fracture. The inter-rater agreement for the detection of VF on VFA was evaluated by kappa statistics. We calculated percent values for the diagnostic validity of VFA in detecting VF in the 100 women as a whole and according to the presence of previous fracture or back pain. RESULTS The prevalence of VF identified by spine radiography was 47%. Inter-rater agreement of VFA per vertebra by two VFA readers showed moderate agreement (kappa=0.60). The sensitivity, PPV, specificity and NPV of VFA compared to spine radiography were 57.3%, 30.9%, 89.1% and 96.1% for total vertebrae. All patients with history of previous VF (n=13) were visualized with VFA with 100% sensitivity but it has 64.7% sensitivity and 79.3% specificity in patients without previous VF (n=87). CONCLUSION VFA is most useful to identify patients without VF because of its high specificity and NPV in all spine level.
Collapse
|
22
|
Abstract
Vertebral compression fractures are a prevalent disease affecting osteoporotic patients. When symptomatic, they cause significant pain and loss of function and have a high public health impact. In this paper we outline the diagnosis and management of these patients, with evidence-based review of treatment outcomes for the various therapeutic options. Diagnosis involves a clinical history focusing on the nature of the patient’s pain as well as various imaging studies. Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing. Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty.
Collapse
|
23
|
Costo-iliac distance: a physical sign of understated importance. Ir J Med Sci 2012; 181:151-3. [DOI: 10.1007/s11845-011-0763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 09/17/2011] [Indexed: 10/17/2022]
|
24
|
Abstract
Current evidence points to suboptimal bone health in children and adolescents with inflammatory bowel disease (IBD) when compared with their healthy peers. This compromise is evident from diagnosis. The clinical consequences and long-term outcome of this finding are still unknown. The mechanism of suboptimal bone health in children and adolescents with IBD lays mainly in reduced bone formation, but also reduced bone resorption, processes necessary for bone growth. Factors contributing to this derangement are inflammation, delayed growth and puberty, lean mass deficits, and use of glucocorticoids. We recognize that evidence is sparse on the topic of bone health in children and adolescents with IBD. In this clinical guideline, based on current evidence, we provide recommendations on screening and monitoring bone health in children and adolescents with IBD, including modalities to achieve this and their limitations; monitoring of parameters of growth, pubertal development, and reasons for concern; evaluation of vitamin D status and vitamin D and calcium intake; exercise; and nutritional support. We also report on the current evidence of the effect of biologics on bone health in children and adolescents with IBD, as well as the role of bone active medications such as bisphosphonates. Finally, we summarize the existing numerous gaps in knowledge and potential subjects for future research endeavors.
Collapse
|
25
|
Vertebroplasty for acute osteoporotic spinal fractures-best evidence? J Vasc Interv Radiol 2010; 21:1330-3. [PMID: 20800775 DOI: 10.1016/j.jvir.2010.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 05/23/2010] [Accepted: 06/07/2010] [Indexed: 01/01/2023] Open
|
26
|
Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis. BMC Palliat Care 2009; 8:12. [PMID: 19740423 PMCID: PMC2746801 DOI: 10.1186/1472-684x-8-12] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 09/09/2009] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Spinal fractures are a common source of morbidity in cancer patients. Balloon Kyphoplasty (BKP) is a minimally invasive procedure designed to stabilize fractures and correct vertebral deformities. We performed a meta-analysis to determine the efficacy and safety of BKP for spinal fractures in cancer patients. METHODS We searched several electronic databases up to September 2008 and the reference lists of relevant publications for studies reporting on BKP in patients with spinal fractures secondary to osteolytic metastasis and multiple myeloma. Outcomes sought included pain relief, functional capacity, quality of life, vertebral height, kyphotic angle and adverse events. Studies were assessed for methodological bias, and estimates of effect were calculated using a random-effects model. Potential reasons for heterogeneity were explored. RESULTS The literature search revealed seven relevant studies published from 2003 to 2008, none of which were randomized trials. Analysis of those studies indicated that BKP resulted in less pain and better functional outcomes, and that these effects were maintained up to 2 years post-procedure. While BKP also improved early vertebral height loss and spinal deformity, these effects were not long-term. No serious procedure-related complications were described. Clinically asymptomatic cement leakage occurred in 6% of all treated levels, and new vertebral fractures in 10% of patients. While there is a lack of studies comparing BKP to other interventions, some data suggested that BKP provided similar pain relief as vertebroplasty and a lower cement leakage rate. CONCLUSION It appears that there is level III evidence showing BKP is a well-tolerated, relatively safe and effective technique that provides early pain relief and improved functional outcomes in patients with painful neoplastic spinal fractures. BKP also provided long-term benefits in terms of pain and disability. However, the methodological quality of the original studies prevents definitive conclusions being drawn. Further investigation into the use of BKP for spinal fractures in cancer patients is warranted.
Collapse
|
27
|
Estimation of resource utilization associated with osteoporotic hip fracture and level of post-acute care in China. Curr Med Res Opin 2007; 23:2937-43. [PMID: 17931462 DOI: 10.1185/030079907x233061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Research suggests that the incidence and cost of treating osteoporotic hip fracture (OHF) in China is rising. The purpose of this study was to estimate resource utilization associated with OHF, including hospital length of stay (LOS) and inpatient costs, and to examine the level of post-acute care for osteoporosis among patients hospitalized for OHF in Shanghai, China. METHODS This was a retrospective study of 2855 patients aged 50 years and older who were hospitalized for bone fragility hip fractures in 13 districts of Shanghai in the 2000. One hundred and one patients were randomly selected and interviewed to determine the treatments and associated costs for the 6-month period following hospitalization. Log linear regressions with bootstrapping resampling were conducted for LOS and hospital cost data to estimate the average LOS and associated costs after adjusting for demographic and comorbid characteristics. RESULTS Hospital records of 2855 patients (mean age, 73.6 +/- 9.9 years) were reviewed. For women, mean LOS (35 days) was longer for those greater than 60 years of age; however, mean cost of hospital stay (15 082 RMB) increased to a peak at age 65-74 years (18 932 RMB). For men, mean LOS (34 days) and mean cost of hospitalization (13 149 RMB) both increased with age. Only 14% of patients hospitalized for OHF received treatment for osteoporosis. Due to the small number of patients and sampling that was taken largely for geographical convenience, care should be taken when generalizing these data into other areas of China. CONCLUSIONS OHF is associated with substantial resource utilization in Shanghai, China. Although patients hospitalized with OHF should be considered for osteoporosis therapy to alleviate economic and patient burden, most patients with OHF received no such treatment.
Collapse
|
28
|
Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 2006; 31:2963-6. [PMID: 17139228 DOI: 10.1097/01.brs.0000247802.91724.7e] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective consecutive series. OBJECTIVE To analyze supine and standing radiographs and the association of back pain using subjective pain criteria. SUMMARY OF BACKGROUND DATA It has been considered that there is little correlation between the degree of collapse of the vertebral body and the level of pain. In previous studies, however, measurements have only been based on supine radiographs. Although there were 2 authors who reported the results of supine lateral and standing lateral radiographs in patients with thoracolumbar vertebral fractures, as far as we know, there has not been any detailed report concerning the correlation between radiologic findings using supine and standing lateral radiographs and back pain. METHODS We examined 100 consecutively treated patients, prospectively. Back pain and the supine and standing radiographs were assessed 1 month after injury. Changes in vertebral wedging rate (WR) from supine to standing position (Delta WR) was reported by the following equation: Delta WR = WR(standing)-WR(supine). RESULTS The median age of the cohort was 75 years (range, 60-89 years). The median VAS of back pain at supine position, at standing position, and when standing erect was 13, 33, and 41, respectively. The median wedging rate on the supine and standing radiographs were 28% and 37%, respectively (P < 0.001). There was a significant correlation between Delta WR and back pain when standing erect (r = 0.79, P < 0.001). CONCLUSION Changes in vertebral wedging rate between supine and standing position and its association with back pain may give a clue to the pathogenesis of pain from osteoporotic thoracolumbar vertebral compression fractures.
Collapse
|
29
|
Statin but not non-statin lipid-lowering drugs decrease fracture risk: a nation-wide case-control study. Calcif Tissue Int 2006; 79:27-36. [PMID: 16868664 DOI: 10.1007/s00223-006-0024-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 04/08/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Discrepant results have been reported on association between treatment with lipid lowering drugs and fracture risk. Several studies have failed to demonstrate an effect of statins on bone mineral density. Therefore, the epidemiological findings of a reduced fracture risk may be due to selections bias, e.g. a healthy drug user effect. If so, the reduced fracture risk is most likely independent of type of lipid lowering drug. AIM We assessed fracture risk in users of various lipid-lowering drugs. METHODS In a case-control design, we compared 124,655 fracture cases with 373,962 age- and gender-matched controls. We used computerized registers to assess individual drug use and related these data to individual fracture data and information on potential confounders. RESULTS Use of statins was associated with a reduced risk of any fracture (adj. OR 0.87; 95% CI, 0.83-0.92) and hip fractures (adj. OR 0.57; 95% CI, 0.48-0.69). Risk of hip fracture decreased with increased accumulated dose of statins. This was true in men and in women and in subjects younger and older than 65 years of age. However, fracture risk was not reduced in patients treated with pravastatin (adj. OR 1.02; 95% CI, 0.89-1.17) or non-statin lipid lowering drugs (adj. OR 0.99; 95% CI, 0.86-1.15). CONCLUSIONS The reduced fracture risk in users of lipid lowering drugs is apparently specifically related to users of non-pravastatin statins. Our findings do not support the hypothesis of a healthy drug user effect as an explanation for the reduced fracture risk in users of statins.
Collapse
|