Progression of vertebral deformity of prevalent vertebral fractures in the elderly: a population-based study

Prevalence and incidence of osteoporotic vertebral fractures in community-dwelling European older adults: an observational analysis of the DO-HEALTH trial

We examined vertebral fracture (VF) prevalence, incidence, and treatment among 1488 older adults. VF prevalence and incidence were higher in women, older participants, and those with low bone density. In addition to VFs being underdiagnosed (only 20.7% of VFs clinically recognized), treatment rates were low, underscoring the need for improved screening and management.

PURPOSE

To estimate prevalence and incidence of osteoporotic VFs and VF progressions overall and by sex, age, and bone status and to describe the proportion of participants with VFs in reporting osteoporosis (OP) medication use.

METHODS

This observational analysis of the DO-HEALTH trial, a three-year, randomized, controlled trial among community-dwelling adults age ≥ 70 years, includes a subsample of participants recruited at four study sites equipped with DXA machines. Prevalence and incidence rates (IR) of VFs and VF progressions were described overall and by subgroups of sex, age, and bone status. Incidence of VFs which were clinically recognized was also estimated. Further, we estimated the proportion of participants on OP medication.

RESULTS

A total of 1488 participants were included (mean age 74.9 years, 63.1% women, 77.0% had osteopenia or osteoporosis). One hundred forty-four (9.7%) participants had at least one radiographic VF at baseline and of those 19.4% participants reported OP medication use. Over the three-year follow-up, 50 participants sustained 58 new radiographic VFs (IR 1.4, 95% CI 1.1, 1.9). Of the 58 radiographic VFs, only 12 (20.7%) were clinically recognized. Furthermore, 31 participants sustained 35 VF progressions (N = 157; IR 7.7, 95% CI 5.5, 10.7). Prevalence and incidence were significantly higher in women, in older participants and those with osteopenia or osteoporosis compared to those with normal bone density.

CONCLUSIONS

This study suggests a high prevalence and incidence of VFs in community-dwelling European older adults. Underdiagnosis may be even more prevalent than previously observed, and treatment rates were low.

L5 osteotomy combined with adjuvant romosozumab therapy for L5 osteoporotic vertebral fracture-induced spinal deformity: illustrative case

BACKGROUND

Spinal reconstruction of an L5 osteoporotic vertebral fracture (OVF) is a demanding surgery because of the condition's rarity, poor bone quality, and anatomical reasons. To date, there has been little debate regarding the surgical strategy for L5 OVF and effective osteoporosis treatment. The authors report L5 osteotomy and adjuvant romosozumab (ROMO) therapy for L5 OVF-induced spinal deformity.

OBSERVATIONS

A 73-year-old woman underwent lumbopelvic instrumentation and fusion from L3 to the pelvis, L5 osteotomy combined with unilateral posterior vertebral column resection (VCR), followed by expandable cage replacement and bone biopsy simultaneously. Histomorphometric analysis of the bone biopsy showed accelerated bone formation in the endocortical region of the spinous process. After surgery, her low back pain and leg pain improved with satisfactory global alignment. At the 2-year follow-up, lumbopelvic reconstruction achieved fusion, with minimal reciprocal change and no mechanical failure. The patient's Oswestry Disability Index improved from 64% to 24%. L5 osteotomy combined with unilateral VCR and expandable cage replacement was a safe and effective technique in this case.

LESSONS

This technique can provide both greater restoration of lower lumbar lordosis and pelvic tilt with fusion. Moreover, adjuvant ROMO therapy has the potential to prevent osteoporosis-related complications. https://thejns.org/doi/10.3171/CASE24633.