Background Vertebral fractures are linked with the increased mortality and morbidity as well as with higher risk against new fractures. Timely diagnostic is very important for the further treatment. 2/3 of fractures are clinically unrecognized
Objectives Prospective follow up with three years of examination of patients with osteoporosis and vertebral fractures treated with bysifosfonates on the incidence of new fractures.
Methods 77 post-menopausal women older than 65, having osteoporosis, have been analyzed. Upon completed densitometry examination of lumbosacral part of the spine (LS) L1-L4 and the hip, which helped identification of osteoporosis, X-ray test of the Th4 - L5 portion of the spine was made for all the patients, aimed at detecting vertebral fractures, AP and profile, which have been analyzed by semi-quantitative method ( Genant,1993); the analysis was made by a radiologist. Patients were treated with weekly (82%), monthly(13%)and intravenous(5%) bisfosfonates, 5600 weekly vitamin D3 supplementation and calcium carbonate 500 IU daily. During three years of treatment, follow up was done for vertebral fractures, any new fractures and BMD changes.
Results Average age of the patients ranged between 70,4±6,8 years, at the beginning, and average age at the end of study ranged between 73±7,2 years.
BMI 24.4±5.9kg/m2, at the end 22± kg/m2, height 155.8±4.5cm, at the end 154±3,2, menopause started 18.9±5.4 years ago.
Vertebral fractures were found out in 21 patients(27.27%). Symptomatic fractures were reported by 4 (19.04%)5,1%, patients whereas 17(80.95%)22,1% patients had the asymptomatic ones. One fracture was registered with 11 (53%) patients, 2 fractures with 6 (29%), and 3 and more with 4 (19%) patients. 1st degree fractures, according to Genant, were found out in 12 (57%), 2nd degree fractures were registered with 8 (38%) patients and 3rd degree fractures with 1(5%) patient.
Study was finished after three years, and same diagnostic procedures were made(RTG, DXA). On follow up there were 71 (92,2%)patients, one developed colon carcinoma(1,2%), 2 died from cardiovascular death (2,5), and 3 left study due to gastrointestinal reasons 3,8%.
Since it concerns fractures, one had fracture of femur (1,3%), two (2,7%) fractures of radius loco typico, and there were no new vertebral fractures. New fractures occurred in a group which did not have registered vertebral fractures at the beginning of the study.
Increase of BMD and Tscore was noticed. The folow up is statistically significant in regard to the beginning on LS 6%, on hip 4% P<0,01, .
Conclusions The results obtained from research indicate a high percentage of asymptomatic vertebral fractures in the examined group of elderly postmenopausal women having osteoporosis. After three years of treatment with bisfosfonates they had low percent of new fractures, there was increase of BMD registered, no new vertebral fractures, and three new non-vertebral fractures.
Disclosure of Interest None Declared
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