Thoracolumbar flexion dysfunction and thoracolumbar compression fracture in postmenopausal women: a single-center retrospective study

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Abstract

Objective

To investigate whether thoracolumbar flexion dysfunctions increase the risk of thoracolumbar compression fractures in postmenopausal women.

Methods

The records of postmenopausal women with thoracolumbar vertebral compression fractures and without vertebral compression fractures were surveyed. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, Spearman, and Mann–Whitney U were used to assess the group characteristics and proportions. The relationship between the risk of fracture and the difference of Cobb’s angle of thoracolumbar segment (DCTL) was evaluated by logistic regression. DCTL was calculated by subtracting thoracolumbar Cobb’s angles (TLCobb’s) from thoracolumbar hyperflexion Cobb’s angles (TLHCobb’s). Quantitative computed tomography (QCT) values and spinal osteoarthritis (OA) of postmenopausal women in the two groups were compared.

Results

102 of 312 were enrolled to the study group of postmenopausal women with the fracture, and 210 of 312 were enrolled to the control group of postmenopausal women without the fracture. There were significant differences in QCT values and spinal OA including disc narrowing (DSN) and osteophytes (OPH) between the two groups ( p < 0.001 for all four). The risk of thoracolumbar compression fractures in the postmenopausal women with DCTL ≤ 8.7° was 9.95 times higher (95% CI 5.31–18.64) than that with > 8.7° after adjusting for age, BMI, and QCT values.

Conclusion

Low DCTL may be a risk factor of thoracolumbar compression fractures in postmenopausal women, and a DCTL ≤ 8.7° can be a threshold value of thoracolumbar compression fractures.

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Most cited references 43

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Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.

Russel Burge, Bess Dawson-Hughes, Daniel Solomon … (2007)

This study predicts the burden of incident osteoporosis-related fractures and costs in the United States, by sex, age group, race/ethnicity, and fracture type, from 2005 to 2025. Total fractures were >2 million, costing nearly $17 billion in 2005. Men account for >25% of the burden. Rapid growth in the disease burden is projected among nonwhite populations. The aging of the U.S. population will likely lead to greater prevalence of osteoporosis. Policy makers require precise projections of the disease burden by demographic subgroups and skeletal sites to effectively target osteoporosis intervention and treatment programs. A state transition Markov decision model was used to estimate total incident fractures and costs by age, sex, race/ethnicity, and skeletal site for the U.S. population 50 years of age for 2005-2025. More than 2 million incident fractures at a cost of $17 billion are predicted for 2005. Total costs including prevalent fractures are more than $19 billion. Men account for 29% of fractures and 25% of costs. Total incident fractures by skeletal site were vertebral (27%), wrist (19%), hip (14%), pelvic (7%), and other (33%). Total costs by fracture type were vertebral (6%), hip (72%), wrist (3%), pelvic (5%), and other (14%). By 2025, annual fractures and costs are projected to rise by almost 50%. The most rapid growth is estimated for people 65-74 years of age, with an increase>87%. An increase of nearly 175% is projected for Hispanic and other subpopulations. Osteoporosis prevention, treatment, and education efforts should address all skeletal sites, not just hip and vertebral, and appropriate attention is warranted for men and diverse race/ethnicity subgroups.

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European guidance for the diagnosis and management of osteoporosis in postmenopausal women

J.A. Kanis, C. Cooper, R Rizzoli … (2018)

Summary Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. Introduction The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. Methods Systematic reviews were updated. Results The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. Conclusions A platform is provided on which specific guidelines can be developed for national use.

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Diagnosis of osteoporosis and assessment of fracture risk.

John Kanis (2002)

The diagnosis of osteoporosis centres on the assessment of bone mineral density (BMD). Osteoporosis is defined as a BMD 2.5 SD or more below the average value for premenopausal women (T score < -2.5 SD). Severe osteoporosis denotes osteoporosis in the presence of one or more fragility fractures. The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA). Other sites and validated techniques, however, can be used for fracture prediction. Although hip fracture prediction with BMD alone is at least as good as blood pressure readings to predict stroke, the predictive value of BMD can be enhanced by use of other factors, such as biochemical indices of bone resorption and clinical risk factors. Clinical risk factors that contribute to fracture risk independently of BMD include age, previous fragility fracture, premature menopause, a family history of hip fracture, and the use of oral corticosteroids. In the absence of validated population screening strategies, a case finding strategy is recommended based on the finding of risk factors. Treatment should be considered in individuals subsequently shown to have a high fracture risk. Because of the many techniques available for fracture risk assessment, the 10-year probability of fracture is the desirable measurement to determine intervention thresholds. Many treatments can be provided cost-effectively to men and women if hip fracture probability over 10 years ranges from 2% to 10% dependent on age.

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Author and article information

Contributors

Xuesong Zhang: zhangxs301@yeah.net

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 7 December 2021

Publication date PMC-release: 7 December 2021

Publication date Collection: 2021

Volume: 16

Electronic Location Identifier: 709

Affiliations

[1 ]GRID grid.488137.1, ISNI 0000 0001 2267 2324, Medical School of Chinese PLA, ; Beijing, China

[2 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Department of Orthopedics, The First Medical Centre, , Chinese PLA General Hospital, ; 28 Fuxing Road, Haidian District, Beijing, China

[3 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Department of Orthopedics, The Fourth Medical Centre, , Chinese PLA General Hospital, ; Beijing, China

Article

Publisher ID: 2857

DOI: 10.1186/s13018-021-02857-w

PMC ID: 8650513

PubMed ID: 34876177

SO-VID: 0117b7da-bbc0-4760-9522-2021930dbb3a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 October 2021

Date accepted : 24 November 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81972128

Award Recipient : Xuesong Zhang

Funded by: FundRef http://dx.doi.org/10.13039/501100009580, General Hospital of People’s Liberation Army;

Award ID: 2019MBD-022

Award Recipient : Wenhao Hu

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: thoracolumbar flexion dysfunction,vertebral fracture,osteoporosis,postmenopausal women,quantitative computed tomography

Data availability:

ScienceOpen disciplines: Surgery

Keywords: thoracolumbar flexion dysfunction, vertebral fracture, osteoporosis, postmenopausal women, quantitative computed tomography

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Thoracolumbar flexion dysfunction and thoracolumbar compression fracture in postmenopausal women: a single-center retrospective study

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25th European Students' Conference

Most cited references 43

Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.

European guidance for the diagnosis and management of osteoporosis in postmenopausal women

Diagnosis of osteoporosis and assessment of fracture risk.

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