The Analysis Of The Risk Factors Related To The Reoccurrence In Patients Who Have Experienced Osteoporotic Vertebral Compression Fracture

Purpose:Osteoporotic Vertebral Compression Fracture(OVCF),as a serious complication of osteoporosis(OP),is affecting more and more individuals.Over 25 percent of women in postmenopausal period suffered from OVCF for once or more,and 40 percent of women at their 80s or elder have experienced OVCF.It is convinced that the risk of reoccurrence of fracture in OVCF patients increases to 5 times than that of fracture for the first time.Through statistical analysis and summarization of the factors such as the age,gender,imageological examination data,laboratory examination results and lifestyle,this article is aiming at exploring the risk factors related to the reoccurrence of OVCF and providing reference of the prevention of reoccurrence in patients with OVCF.The conclusion we draw will make new solutions in continual treatment for OVCF patients possible.Methods:By looking up the in-hospital events of 167 patients(Among those 167 patients,there are 138 cases of female and 29 cases of male matched for age between 49 and 87,at an average age of 72.10±8.73),who suffered OVCF between Jan 1,2015 and Dec 31.2017 and hospitalized in Shandong University Qilu Hospital,we collect the hospitalizing data we need for further research.12 months to 18 months of follow-up visit was set,with an average follow-up period of 14.7 months,and then a group of patients with reoccurrence,characterized as OVCF reoccurrence group(32 cases of female and 9 cases of male)and a group of patients without reoccurrence,characterized as control group(106 cases of female and 20 cases of male)were divided.We collect data including the sex,the age when patients suffer from OVCF for the first time,the age of menopause,weight,lumbar bone mineral density(BMD),the level of bone turnover markers,the number of fracture segment for the first time,the treatment for the first time(drug therapy,or bone cement augmented therapy),the volume of bone cement injection at a single vertebrae in the first operation,the standards degree of anti-osteoporotic therapy after first fracture,the underlying diseases,whether the mate is alive or not,etc.All the data are recorded for further statistical analysis.Results:We integrate 167 cases into our research.Among those cases,there are 138 cases of female,ranging from 49 to 87 years old.The average age of female cases is 72.10±8.73 years old.In OVCF reoccurrence group,the average age of menopause(46.84±2.26 years old)is lower than that in the control group(48.88±3.60 years old),which shows a statistical difference(t=3.014,p<0.001).The average T value of lumbar BMD,serum PTH and Vit-D in OVCF reoccurrence group are-4.13±0.88,33.63±10.39 pg/ml,12.85±8.07 ng/ml ordinally,which are lower than those in the control group with a statistical difference(-3.54±0.85,38.74±13,36 pg/ml,19.40±8.17 ng/ml).The t values in the comparision of the two groups are-3.769,-2.236 and-4.470,and the p values are lower than 0.05.The ratio of patients with underlying disease in OVCF reoccurrence group is 85.37%,which is higher than that in the control group(69.05%)and shows a statistical difference.So is the ratio of patients accepting conservative therapy,which is 36.59%in OVCF reoccurrence group,higher than 15.08%in control group.Both comparisons above have statistical differences with chi-square at the level of 4.185 and 8.824 and p values at the level of 0.041 and 0.003.The ratio of patients with long-term effective anti-osteoporosis treatment in OVCF reoccurrence group is 68.29%,which is significantly lower than that in control group(92.06%)with a statistical difference that the chi-square is 13.271 and p value is lower than 0.001.The average volume of injection of bone cement at single segment of vertebra in OVCF reoccurrence group is 4.77±1.31 ml,which is higher than 3.92± 1.39 ml in the control group with a statistical difference(t=2.817,p=0.006).Based on multiple logistic regression,the lower level of serum Vit-D(OR:0.907,95%CI:0.828-0.995),lower T value of lumbar BMD(OR:0.342,95%CI:0.173-0.675),the higher average volume in injection of bone cement at a single vertebrae(OR:1.498,95%CI 1.076-2.086)and without long-term effective anti-osteoporosis therapy(OR:0.229,95%CI:0.062-0.847)are main risk factors(p<0.05)in patients who have had cement-augmented treatment.The lower level of serum Vit-D(OR:0.787,95%CI:0.621-0.996)is the main risk factor in those patients who accepted conservative treatment.The lower level of serum Vit-D(OR:0.895,95%CI:0.825-0.971),lower T value of BMD(OR:0.243,95%CI:0.110-0.537)and the younger age of menopause(OR:0.738,95%CI:0.618-0.882)are main risk factors in female patients.Conclusion:In patients who accepted cement-augmented therapy after the first occurrence of OVCF,a lower level in serum Vit-D,a lower T value of lumbar BMD,a larger volume in injection of bone cement at a single vertebra and without a long-term effective anti-osteoporosis therapy are factors increasing the risk of reoccurrence of OVCF.In patients with conservative treatment,a lower level of serum Vit-D matters in the reoccurrence of OVCF.As for female patients,a lower level of serum Vit-D,a lower T value of lumbar BMD and an older age of menopause increase the risk of reoccurrence of OVCF.In conclusion,we need to conduct a follow-up more rigorously and take effective intervening measures targetedly.