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Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures.

ABSTRACT: Introduction: Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT prescribing patterns in VCF patients, further assessing the impact of surgical interventions on these patterns. Materials and Methods: Patients with index VCFs between 2010 and 2021 were identified using the PearlDiver database. Diagnostic and procedural data were recorded using International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes. Patients under age 50 and follow-up Results: Of 637,701 patients, 72.6% were female. The overall subsequent hip fracture incidence was 2.6% at one year and 12.9% for all-time follow-up. Propensity-matched analysis indicated higher subsequent hip fracture rates in patients initiated on AOT post-index VCF (one year: 3.8% vs. 3.5%, p = 0.0013; all-time: 14.3% vs. 13.0%, p < 0.0001). Conclusions: The study reveals an unexpected increase in subsequent hip fractures among patients initiated on AOT post-index VCF, likely due to selection bias. These findings highlight the need for refined osteoporosis-management strategies to improve guideline adherence, thereby mitigating patient morbidity and mortality.

SUBMITTER: Ton A

PROVIDER: S-EPMC11355522 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures.

Ton Andy A Bell Jennifer A JA Karakash William J WJ Alter Thomas D TD Erdman Mary Kate MK Kang Hyunwoo Paco HP Mills Emily S ES Ragheb Jonathan Mina JM Athari Mirbahador M Wang Jeffrey C JC Alluri Ram K RK Hah Raymond J RJ

Journal of clinical medicine 20240814 16

<b>Introduction:</b> Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT prescribing patterns in VCF patients, further assessing the impact of surgical interventions on these patterns. <b>Materials and Methods:</b> Patients with index VC ...[more]

PMID: 39200923

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Project description:Rationale: Poly (methyl methacrylate) (PMMA) bone cement is one of the most commonly used biomaterials for augmenting/stabilizing osteoporosis-induced vertebral compression fractures (OVCFs), such as percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP). However, its clinical applications are limited by its poor performance in high compressive modulus and weak bonding to bone. To address these issues, a bioactive composite bone cement was developed for the treatment of osteoporotic vertebral compression fractures, in which mineralized collagen (MC) was incorporated into the PMMA bone cement (MC-PMMA). Methods: The in vitro properties of PMMA and MC-PMMA composite bone cement were determined, including setting time, compressive modulus, adherence, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. The in vivo properties of both cements were evaluated in an animal study (36 osteoporotic New Zealand female rabbits divided equally between the two bone cement groups; PVP at L5) and a small-scale and short-term clinical study (12 patients in each of the two bone cement groups; follow-up: 2 years). Results: In terms of value for PMMA bone cement, the handling properties of MC-PMMA bone cement were not significantly different. However, both compressive strength and compressive modulus were found to be significantly lower. In the rabbit model study, at 8 and 12 weeks post-surgery, bone regeneration was more significant in MC-PMMA bone cement (cortical bone thickness, osteoblast area, new bone area, and bone ingrowth %; each significantly higher). In the clinical study, at a follow-up of 2 years, both the Visual Analogue Score and Oswestry Disability Index were significantly reduced when MC-PMMA cement was used. Conclusions: MC-PMMA bone cement demonstrated good adaptive mechanical properties and biocompatibility and may be a promising alternative to commercial PMMA bone cements for the treatment of osteoporotic vertebral fractures in clinical settings. While the present results for MC-PMMA bone cement are encouraging, further study of this cement is needed to explore its viability as an ideal alternative for use in PVP and BKP.

Project description:BackgroundWith the aging of the world's population, the social and economic implications of osteoporotic fractures are at epidemic proportions. This study was performed to test the hypothesis that a proximal humeral fracture is an independent risk factor for a subsequent hip fracture and that the risk of the subsequent hip fracture is highest within the first five years after the humeral fracture.MethodsA cohort of 8049 older white women with no history of a hip or humeral fracture who were enrolled in the Study of Osteoporotic Fractures was followed for a mean of 9.8 years. The risk of hip fracture after an incident humeral fracture was estimated with use of age-adjusted Cox proportional hazards regression analysis with time-varying variables; women without a humeral fracture were the reference group. Cox regression analysis was used to evaluate the timing between the proximal humeral and subsequent hip fracture. Risk factors were determined on the basis of a review of the current literature, and we chose the variables that were most predictive and easily ascertained in a clinical setting.ResultsThree hundred and twenty-one women sustained a proximal humeral fracture, and forty-four of them sustained a subsequent hip fracture. After adjustment for age and bone mineral density, the hazard ratio for hip fracture for subjects with a proximal humeral fracture relative to those without a proximal humeral fracture was 1.83 (95% confidence interval = 1.32 to 2.53). After multivariate adjustment, this risk appeared attenuated but was still significant (hazard ratio = 1.57; 95% confidence interval = 1.12 to 2.19). The risk of a subsequent hip fracture after a proximal humeral fracture was highest within one year after the proximal humeral fracture, with a hazard ratio of 5.68 (95% confidence interval = 3.70 to 8.73). This association between humeral and hip fracture was not significant after the first year, with hazard ratios of 0.87 (95% confidence interval = 0.48 to 1.59) between one and five years after the humeral fracture and 0.58 (95% confidence interval = 0.22 to 1.56) after five years.ConclusionsIn this cohort of older white women, a proximal humeral fracture independently increased the risk of a subsequent hip fracture more than five times in the first year after the humeral fracture but was not associated with a significant increase in the hip fracture risk in subsequent years.

Project description:BackgroundPatients with vertebral compression fractures may experience unpredictable residual pain following vertebral augmentation. Clinical prediction models have shown potential for early prevention and intervention of such residual pain. However, studies focusing on the quality and accuracy of these prediction models are lacking. Therefore, we systematically reviewed and critically evaluated prediction models for residual pain following vertebral augmentation.MethodsWe systematically searched eight databases (PubMed, Embase, Web of Science, CNKI, WanFang, VIP, and SinoMed) for studies that developed and/or validated risk prediction models for residual pain after vertebral augmentation. The limitations of existing models were critically assessed using the PROBAST tool. We performed a descriptive analysis of the models' characteristics and predictors. Extracted C-statistics were combined using a weighted approach based on the Restricted Maximum Likelihood (REML) method to represent the models' average performance. All statistical analyses were performed using R 4.3.1 and STATA 17 software.ResultsFifteen models were evaluated, involving 4802 patients with vertebral compression fractures post-vertebral augmentation. The overall pooled C-statistic was 0.87, with a 95% CI of 0.83 to 0.89 and a prediction interval ranging from 0.72 to 0.94. The models included 35 different predictors, with posterior fascia injury (PFI), bone mineral density (BMD), and intravertebral vacuum cleft (IVC) being the most common. Most models were rated high risk due to concerns about population selection and modeling methodology, yet their clinical applicability remains promising.ConclusionThe development and validation of current models exhibit a certain risk of bias, and our study highlights these existing flaws and limitations. Although these models demonstrate satisfactory predictive performance and clinical applicability, further external validation is needed to confirm their accuracy in clinical practice. Clinicians can utilize these models alongside relevant risk factors to predict and prevent residual pain after vertebral augmentation, or to formulate personalized treatment plans.

Dataset Information

Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures.

Publications

Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures.

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