Risk Evaluating Of Vertebral Refracture Risk In 2 Years For Post-menopausal Osteoporosis Vertebral Fracture Patients After Bone Cement Augmentation

Purpose:Osteoporosis is a chronic systemic disease highly found in postmenopausal women and the elderly.With the aging of our population,the incidence of this disease is increasing year by year.Fracture is the most serious complication of osteoporosis,and the osteoporotic spinal fracture has "cascade effect ".It is not rare that one patient hospitalizes for several time all because of osteoporotic vertebral fracture.This study analyzed a variety of risk factors,calculated their correlation and weight with vertebral refracture,made the complex calculation formula into a scale form,which is easier for comprehension and spread.And improved the accuracy and generalization of the risk assessment method for spinal recurrence fracture in patients with osteoporosis.Thus,the relationship between doctors and patients would be closer.And it can be more convenient to decide more accurate suggestions for clinical patients on anti-osteoporosis therapy,and urge high-risk patients to strengthen their protection,strictly carry out standardized anti-osteoporosis treatment,reduce the occurrence of adverse events,alleviate the pain of patients,improve the quality of life of patients,and reduce the unnecessary expenses of medical insurance in recurrent fracture.Method:From January 31,2013 to January 31,2018,data of 131 patients were collected,with 12-57 months(mean 26.5 months)follow-up.All the patients are postmenopausal osteoporosis women admitted for osteoporotic vertebral compression fractures and have taken bone cement augmentation operation.Patients were divided into single-fracture in 2 years group(72 cases,age range 62-85 years,mean age 70.38±6.95 years)and refracture in 2 years group(59 cases,age range 60-85 years,mean age 73.24±6.95 years).Information of many aspects are collected,such as general data,clinical data and laboratory data of the patients,including age,height,weight,age of menopause,history of smoking and drinking,types of basic diseases,number of previous osteoporotic fractures,the order and the total number of fractured vertebra,the order and total number of vertebra undergoing surgery,average volume of bone cement injected into the vertebral body during operation,bone turnover markers,serum calcium concentration,etc.Using statistical software to analyze data of the two groups by single-factor analysis.Then Logistic analysis was taken to select factors highly correlated to refracture,calculate their weights.And different values of the variables are transformed to score,so that the scores and probabilities calculated by Logit function can be in correspondence.At last a simplified point scale is obtain to predict refracture risk.Results:In postmenopausal women with osteoporosis who have suffered from osteoporotic spinal fracture and taken bone cement injection surgery.When ?=0.2 was taken as significance level,high risk factors screened were as the follows:menopausal age(P=0.159),multiple previous vertebral fractures(P<0.005),multiple vertebral body fractures found on admission(P=0.031),multiple vertebral bodies undertaking operation during this hospitalization(P=0.193)and excessive volume of cement injected into each vertebral body(P=0.175),non-standard therapy taken for anti-osteoporosis postoperative treatment(?2=3.023,P<0.005),other basic concomitant diseases(?2=20.103,P<0.005),lumbar bone mineral density(P=0.011)and body mass index(P=0.166).These are factors that may differ between the groups of osteoporotic vertebral refracture within two years and of single fracture group.The factors above were then again included in logistic analysis.Four variables were screened out to construct a risk assessment model:the number of previous fractures(P<0.0001,OR=66.58),lumbar bone mineral density(P=0.09,OR=1.79,menopausal age less than or equal to 45 years(P<0.0001,OR=0.04),and average volume of bone cement per vertebral body(P=0.04,OR=2.17).As the model analyzing,multiple previous spinal fractures,low lumbar bone mineral density,premature menopause,excessive injection of bone cement into the vertebral body during surgery are high risk factors for vertebral refracture,which is in consistent with clinical experience and previous academic findings.Conclusion:The prediction model of vertebral refracture includes these four factors:lumbar bone mineral density,number of previous fractures,average volume of bone cement injected into each vertebral body,and age of menopause.It provides a complete framework for evaluating the risk of recurrent vertebral fracture within 2 years in postmenopausal women with osteoporotic fracture treated by bone cement augmentation operation.