한국 여성의 폐경기성 골다공증에 의한 척추 골절의 위험 임자

윤수영(Soo Young Yoon),장준섭(Jun Seop Jahng),박기현(Ki Hyun Park),임승길(Sung Kil Lim) 대한내과학회 1999 대한내과학회지 Vol.57 No.2

Background: Osteoporotic fracture is an important cause of disability in elderly women, and vertebral fractures are the most common of aU osteoporotic fractures. To prevent osteoporotic vertebral fracture, risk factor identification is necessary, therefore, we examined the relationship between the well-known risk factors for osteoporosis or falls and vertebral fracture. Methods : A total 105 Korean women aged 50-76 and had postmenopausal osteoparosis were enrolled in this study. We examined the factors attributing to develop the osteoporotic vertebral fractures through comparing the arthropometric data, past and family histories of fractures, amount of exer#cise, risk factors for falls, biochemical markers, and bone mineral densities. Results : 41 had one or more vertebral fractures and 64 had no vertebral fracture. Compared to women without vertebral fracture, women with vertebral fractures were older, smaller and showed higher waist-hip ratio and larger degree of kyphosis. History of previous fractures had a significant correlation with vertebral fractures and spending a few hours daily on the feet was a risk factor for osteoporotic vertebral fractures. Women who had no vertebral fracture had greater muscle mass of leg, walked faster, and tolerated more time in tandem position than who had any osteoporotic. vertebral fracture. Compared to the non-fractured group, serum albumin level was lower in the fractured group, and urine deoxypyridinoline/creatinine ratio, the bone resorption marker, was greater in the fractured group as predicted. Women without any fracture had greater bone mineral density of femoral neck and lumbar vertebrae. In Logistic regression analysis, waist-hip ratio, history of previous fractures, degree of kyphosis, and thigh circumference were the risk factors for the osteoporotic vertebral fracture. Conclusion : It could be possible to prevent osteoporotic vertebral fractures by efforts to identify and reduce the risk factors. But prospective studies should be performed regatding social and traditional characteristics of Korea.

Plasma periostin associates significantly with non-vertebral but not vertebral fractures in postmenopausal women: Clinical evidence for the different effects of periostin depending on the skeletal site

Kim, Beom-Jun,Rhee, Yumie,Kim, Chong Hwa,Baek, Ki Hyun,Min, Yong-Ki,Kim, Deog-Yoon,Ahn, Seong Hee,Kim, Hyeonmok,Lee, Seung Hun,Lee, Sun-Young,Kang, Moo-Il,Koh, Jung-Min Elsevier 2015 Bone Vol.81 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Periostin is preferentially expressed by the periosteum, which mainly covers the long bones. Therefore, the role of periostin in osteoporotic fracture (OF) may differ depending on bone type. We performed a case–control study to investigate whether periostin can serve as a predictor of OF risk, particularly after dividing OFs into non-vertebral and vertebral fractures.</P> <P><B>Methods</B></P> <P>Among 532 consecutive postmenopausal women not taking any drug or without any disease that could affect bone metabolism, 133 cases with OF (<I>i.e.</I>, non-vertebral and/or vertebral fractures) and 133 age- and body mass index-matched controls were enrolled. Non-vertebral (<I>i.e.</I>, forearm, humerus, hip, and pelvis; n=81) and morphological vertebral (n=62) fractures were identified by an interviewer-assisted questionnaire and lateral thoracolumbar radiographs, respectively. Bone mineral density (BMD) and plasma periostin levels were also measured.</P> <P><B>Results</B></P> <P>Plasma periostin was markedly higher in subjects with non-vertebral fracture than their controls even after adjustment for BMD and potential confounders (<I>P</I> =0.006). Each standard deviation increment of plasma periostin was associated with a multivariable-adjusted odds ratio of 1.59 for non-vertebral fracture. The odds for non-vertebral fracture were 2.48-fold higher in subjects in the highest periostin tertile compared with those in the lowest periostin tertile (95% confidence interval=1.10–5.61). However, associations between plasma periostin and vertebral fracture were not observed, regardless of the adjustment model used. Consistently, plasma periostin levels were inversely associated with proximal femur BMD (<I>P</I> =0.007 to 0.030) but not lumbar spine BMD. In subgroup analyses, plasma periostin had no correlation with the levels of classical bone turnover markers.</P> <P><B>Conclusions</B></P> <P>Plasma periostin may be a potential biomarker of the risk of OF, especially in non-spinal skeletal sites, such as the limbs, rather than spine.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Subjects with osteoporotic non-vertebral fracture showed markedly higher plasma periostin levels than their controls. </LI> <LI> Subjects in the highest periostin tertile had a 2.48-fold higher risk of non-vertebral fracture. </LI> <LI> Vertebral fracture did not associate with plasma periostin levels, regardless of the adjustment model used. </LI> <LI> Consistently, plasma periostin levels were inversely associated with proximal femur BMD but not lumbar spine BMD. </LI> </UL> </P>

Early Adjacent Vertebral Fractures after Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Bong-Seong Ko,Kyu Jung Cho,Jae-Woo Park 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: Retrospective cohort study. Purpose: To evaluate the incidence and risk factors for early adjacent vertebral fractures following balloon kyphoplasty (KP). Overview of Literature: KP is a safe and effective treatment for pain alleviation in patients with osteoporotic vertebral compression fractures (OVCF). However, some studies have reported that the risk of newly developed fractures increases at the adjacent vertebra after KP. Methods: Total 123 consecutive patients with painful OVCF who underwent KP were enrolled from January 2009 to June 2016. Early adjacent vertebral fractures were defined as new fractures that had developed within 3 months after surgery. Sex, age, body mass index (BMI), bone mineral density (BMD), vertebral height, kyphotic angle, Visual Analog Scale score, cement amount, and leakage were evaluated as risk factors for adjacent vertebral fractures. Only cement leakage into the disc space was included in this study. Results: Early adjacent vertebral fractures were identified in 20 (16.2%) of the 123 patients. The mean time to diagnosis of fractures was 1.7±0.7 months after KP. The average patient age was 78.0±0.7 years, average BMI was 23.06±3.83 kg/m2, and mean BMD was −3.61±1.22 g/m2. Cement leakage was present in 16 patients, and fractures developed in 11 (68.7%). In contrast, fractures developed in nine patients (8.2%) without cement leakage. There were no significant differences in terms of age, BMI, BMD, kyphotic angle, or vertebral body height ratio between the fracture and control groups. Conclusions: Cement leakage into the disc increased the risk of early adjacent vertebral fractures after balloon KP.

골다공증성 척추 골절의 보존적 치료에 대한 생존 분석

고영도,김동준,김락규,김대연,김남기,김종오 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.4

연구 계획: 전향적 연구목적: 골다공증성 척추 골절에서 보존적 치료에 대한 생존율을 분석하여 그에 영향을 미치는 예후 인자를 알아보고자 하였다. 선행문헌의 요약: 최근 고령인구의 증가와 그에 따른 골다공증에 대한 많은 연구가 이루어져 골다공증성 척추 골절은 중대한 합병증을 낳는다고 보고되고 있다. 그러나 아직 그 치료 및 예후에 대하여 명확히 알려진 바는 없다. 대상 및 방법: 한 추체의 골다공증성 척추 골절로 보존적 치료를 받았던 130명의 환자를 대상으로 보존적 치료에 대한 생존분석을 시행하였다. 또한 수상 당시의 나이, 성별, 체질량 지수(BMI), 골밀도 검사, 흡연의 여부, 당뇨의 유병 여부, 골절 부위, 골절 형태, 추체 압박률, 국소 분절 후만각을 측정하여,생존에 대한 단 인자 및 다중 인자 분석을 시행하였다. 결과: 보존적 치료에 대한 생존율은 70.7% 였다. 단 인자 분석상 수상 당시의 나이가 78세 이상(p=0.008), 골밀도 검사상 T 점수 -3.5이하(p=0.047), 골절형태가 설상형 보다 양오목형 또는 압착형에서(p=0.021) 생존율이 유의하게 낮은 것으로 분석되었다. 다중 인자 분석에서는 나이에 따른 요인만이유의한 의미를 보였다(p=0.025, Hazard ratio=2.08). 결론: 한 추체의 골다공증성 척추 골절에서 보존적 치료는 70.7%의 생존율을 보였으며, 나이가 보존적 치료의 가장 중요한 인자로 분석 되었다. 나이가78세 이상의 고령인 경우 보존적 치료의 고 위험임을 미리 인지할 필요가 있을 것으로 사료된다. Study Design: Prospective study. Objectives: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. Summary of Literature Review: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. Materials and Methods: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb’s angle. Results: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). Conclusion: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study

Yamamoto Masatoshi,Ohta Koji,Hirano Daisuke,Noguchi Maki,Ayukawa Shuhei,Shirasaki Keigo,Ishizu Kenya,Watanabe Tetsuya,Iida Keiichiro 대한척추외과학회 2025 Asian Spine Journal Vol.19 No.3

Study Design: Retrospective cohort study. Purpose: To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures. Overview of Literature: Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP. Methods: We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated. Results: The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk. Conclusions: Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.

Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures

박세준,정성수 대한골다공증학회 2011 Osteoporosis and Sarcopenia Vol.9 No.2

Objectives: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures. Methods: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image. Results: The average VBB ratio was 49.1% and the average change of AWA was 7.1o. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse. Conclusions: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

Lower SMI is a risk factor for dysphagia in Japanese hospitalized patients with osteoporotic vertebral and hip fracture: A retrospective study

Kaoru Suseki,Masaomi Yamashita,Yoshiaki Kojima,Yojiro Minegishi,Koichiro Komiya,Masashi Takaso 대한골다공증학회 2022 Osteoporosis and Sarcopenia Vol.8 No.4

Objectives: Many patients with osteoporotic fragile fracture often suffer from dysphagia that results in malnutrition, further deterioration of physical strength, and rehabilitation difficulties. This study aims to investigate the risk factors for dysphagia in hospitalized patients with osteoporotic vertebral and/or hip fractures. Methods: Between January 2020 and December 2021, 569 inpatients were managed for osteoporotic vertebral or hip fractures. Of these, 503 patients were analyzed and 66 were excluded as the required data could not be obtained or dysphagia with causative diseases such as cerebrovascular disease. The patients were divided into 2 groups: patients with dysphagia (P-group) and patients without dysphagia (N-group). We investigated gender, fracture site, age, systemic skeletal muscle mass index (SMI), bone mineral density (BMD), and body mass index (BMI) in early stage of hospitalization and studied their relationship with dysphagia. Results: There were no significant differences in gender and fracture site between the 2 groups. A significant difference was observed in age, SMI, BMD, and BMI (P < 0.01). We performed a logistic regression analysis with the P-group as the objective variable and age, SMI, BMD, and BMI as explanatory variables. We divided objective groups into all patients, patients with vertebral fracture, patients with hip fracture, men, and women. SMI was an independent risk factor in all groups. Conclusions: Lower SMI was a risk factor for dysphagia in hospitalized patients with osteoporotic vertebral and hip fractures. We carefully observed swallowing function of patients with decreased SMI to maintain the nutritional status and prevent rehabilitation difficulties.

Physical Functions and Comorbidity Affecting Collapse at 4 or More Weeks after Admission in Patients with Osteoporotic Vertebral Fractures: A Prospective Cohort Study

Umehara Takuya,Inukai Ayaka,Kuwahara Daisuke,Kaneyashiki Ryo,Kaneguchi Akinori,Tsunematsu Miwako,Kakehashi Masayuki 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.3

Study Design: A prospective cohort study.Purpose: This study aimed to reveal physical functions and comorbidity affecting collapse at ≥4 weeks after hospital admission of patients with osteoporotic vertebral fracture.Overview of Literature: Only a few studies have investigated the influence of physical function and activity on collapse in patients with osteoporotic vertebral fractures.Methods: This prospective cohort study analyzed patients with osteoporotic vertebral fractures admitted to the hospital between March 2018 and October 2019. Logistic regression analysis was performed to explore the predictors of vertebral collapse at >4 weeks after admission. Model 1 used basic medical information and physical functions at admission; model 2 used basic medical information and physical function and activity at >4 weeks after admission.Results: In the model 1 results of logistic regression analysis, cardiovascular disease (odds ratio [OR], 12.27; 95% confidence interval [CI], 1.28–117.91) was extracted as a factor affecting vertebral collapse at ≥4 weeks after admission. In the model 2 results of logistic regression analysis, cardiovascular disease (OR, 34.57; 95% CI, 2.53–471.74), movement control during one leg standing at 4 weeks (OR, 7.25; 95% CI, 1.36–38.71), and Pain Catastrophizing Scale score at 4 weeks (OR, 1.11; 95% CI, 1.01–1.21) were extracted as factors affecting vertebral collapse at ≥4 weeks after admission.Conclusions: Our results indicate that physical functions and comorbidity affect collapse at ≥4 weeks after admission in patients with osteoporotic vertebral fractures.

Quality of Life in Patients with Osteoporotic Vertebral Fractures

윤상필,이승환,기철현,이영태,홍성하,이환모,문성환 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5

Study Design: A case-control study. Purpose: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women with osteoporotic vertebral fractures, compared with a control group. Overview of Literature: Osteoporotic vertebral fractures are a major cause of morbidity among postmenopausal women. There have been many reports of a decrease in the quality of life in patients with osteoporotic vertebral fractures. However,few reports have analyzed which dimensions contribute to the decline in quality of life. Methods: One thousand five hundred forty-five postmenopausal women aged 50 years and older from 17 study sites in nationwide hospitals were in enrolled in the study (between April 2008 and January 2009). HRQL was measured using the European Quality of Life 5 Domains (EQ-5D), and visual analogue scale (VAS). Results: The average VAS of the case group was 57.80, and that of the control group was 64.10 (p =0.001). All domains of the EQ- 5D score were significantly worse in the case group (p =0.001). Among the case group, the average VAS of the 559 patients (45%) who were operated on was 56.8, and that of the remaining 680 patients (55%) who were treated conservatively was 58.6 (p =0.135). Among the case group, the averages of each EQ-5D domain of the 559 patients (45%) who were operated on were: 1.87 in mobility, 1.81 in self-care, 1.99 in usual activities, 2.11 in pain, and 1.62 in anxiety or depression. Those of the 680 patients (55%) who were treated conservatively were: 1.72 in mobility, 1.60 in self-care, 1.76 in usual activities, 1.98 in pain, and 1.57 in anxiety or depression. Except for the domain of anxiety or depression, scores for the other domains were all significantly worse in the patients who were operated on (p =0.001). Conclusions: Health related quality of life in the patients with osteoporotic vertebral fractures was significantly worse in both the EQ-5D domains and VAS. Among the osteoporotic vertebral fracture patients, the patients who were operated on had a worse quality of life in EQ-5D.

골다공증 척추골절에서 흉요추 시상균형의 지표로서 제 1요추 경사

이상민,박지훈,장영재,심승우,백성년,최용수 대한척추외과학회 2020 대한척추외과학회지 Vol.27 No.3

Study Design: Feasibility study. Objectives: To evaluate the association between L1 slope and thoracolumbar spinal parameters of sagittal balance in cases of osteoporotic vertebral fracture. Summary of Literature Review: Recently, interest has emerged in the sagittal parameters of the thoracolumbar spine in cases of osteoporotic vertebral fracture. Materials and Methods: Eighty-five patients were enrolled in this study, including 36 patients with recent osteoporotic vertebral fractures (group 1) and 49 patients who did not have vertebral fractures (group 2). Radiographic parameters including L1 slope, C7 plumb line (C7 PL), sagittal imbalance (C7 PL >50 mm), lumbar lordosis, thoracic kyphosis, pelvic tilt, S1 slope, local kyphotic angle were evaluated on standing lateral radiographs of the whole spine. We analyzed correlations between L1 slope and these parameters. Results: Of the sagittal parameters of the spine, the mean L1 slope, C7 PL, thoracic kyphosis, lumbar lordosis, S1 slope, pelvic tilt, and local kyphotic angle were 10.43°, 92.43 mm, 29.30°, 30.31°, 25.27°, 27.27°, 9.90° in group 1 and 9.41°, 68.50 mm, 20.09°, 23.25°, 22.03°, 31.43°, 8.21° in group 2, respectively. There were significant differences in thoracic kyphosis (p=0.01) and lumbar lordosis (p=0.04) between the two groups. L1 slope was positively correlated with thoracic kyphosis (r=0.46, p=0.01), lumbar lordosis (r=0.51, p=0.01), and local kyphotic angle (r=0.29, p=0.04) in group 1. Conclusions: These results suggest that L1 slope is a central indicator for the evaluation of thoracolumbar sagittal balance in osteoporotic vertebral fractures. 연구 계획: 타당성조사목적: 골다공증 척추골절에서 제 1요추경사와 흉요추의 시상균형지표와 관련성을 평가하고자 하였다. 선행 연구문헌의 요약: 최근 골다공증 척추골절에서 흉요추의 시상균형지표에 대한 관심이 증가하고 있다. 대상 및 방법: 골다공증 척추골절이 발생한 36명의 환자(그룹 1), 척추골절이 발생하지 않았던 49명의 환자(그룹 2), 총 85명의 환자를 연구대상으로 하였다. 척추전장기립측면 단순방사선검사에서 방사선지표로 제 1요추경사, 제 7경추수선, 시상불안정성(제 7경추수선>50 mm), 요추전만각, 흉추후만각, 골반기울기, 천추경사, 국소후만각을 측정하였고, 제1 요추경사와 방사선지표들의 상관관계를 분석하였다. 결과: 척추의 방사선지표인 제 1요추경사, 제 7경추수선, 흉추후만각, 요추전만각, 천추경사, 골반기울기, 국소후만각이 그룹 1에서 10.43도, 92.43 mm, 29.30도, 30.31도, 25.27도, 27.27도, 9.90도, 그룹 2에서 9.41도, 68.50 mm, 20.09도, 23.25도, 22.03도, 31.43 도, 8.21도로 각각 확인되었다. 양 군간의 흉추후만각(p=0.01), 요추전만각(p=0.04)에서 통계학적으로 유의한 차이를 보였다. 제 1요추경사는 흉추후만각(r=0.46, p=0.01), 요추전만각(r=0.51, p=0.01), 국소후만각(r=0.29, p=0.04)과 양의 상관관계를 보였다. 결론: 제 1요추경사는 골다공증 척추골절환자에서 흉요추의 시상균형을 평가하는 지표의하나로 사용될 수 있으리라 사료된다. 약칭 제목: 흉요추 시상균형으로 제 1요추경사