Background Clinical vertebral fracture can be a serious and disabling complication in patients with osteoporosis (OP). Although spine X-ray can easily confirm the diagnosis, it's very important to know the radiological evolution of the fracture in the following weeks in order to establish a suitable therapeutic approach.
Objectives To assess the radiological outcome in patients with acute symptomatic osteoporotic vertebral fracture in the first 8 weeks of symptoms. To analyze what clinical variables are associated with radiological progression, defined as an increase in the severity of the fracture or the presence of new vertebral fractures.
Methods All patients with acute osteoporotic vertebral fracture attended in a quickly specific OP clinic, from January 2013 to October 2014 were included. Patients who have undergone vertebroplasty, and patients with previous diagnosis or receiving treatment for OP (including calcium and vitamin D) were excluded. All patients gave their consent to participate in the study.
Clinical evaluation of vertebral pain (VAS), lateral thoracic and lumbar spine X-ray (to establish the number and severity of vertebral fractures according to the Genant semiquantitative scale), DXA (lumbar spine, femoral neck and total hip BMD) and phospho-calcium metabolism parameters (Ca, P, 25OHD, PTH) were assessed in all patients at baseline. A new clinical assessment of vertebral pain and spine X-ray were performed at 8 weeks.
Results 31 patients (24 women and 7 men) were included. Mean age 74±9 years. Sixteen patients had postmenopausal osteoporosis and 15 secondary osteoporosis (6 early menopause, 5, corticosteroids, 4 other causes). 10-year fracture risk (FRAX) was 17.1±11.0 for major fracture and 8.7±8.4 for hip fracture.
All patients were early assessed (less than 1 month after the onset of symptoms of vertebral pain). At baseline VAS for pain was 8.8±1.3. Lateral thoracic and lumbar spine X-ray showed 53 vertebral fractures in 31 patients (1.7±0.9 fractures per patient): 17 patients had 1 vertebral fracture, 7 patients had 2 vertebral fractures and other 7 patients had 3 or more vertebral fractures. Five patients also had some previous non-vertebral fractures. The mean vertebral fracture severity was 1.6±0.6 (13 patients grade 0-1, 18 patients grade>1).
Baseline T-score at lumbar spine and femoral neck was -3.0±1.3 and -2.4±0.6 respectively. Mean 25(OH)D and PTH was 22.9±12.9 ng/ml and 66.6±31.6 pg/ml respectively.
At 8 weeks, despite clinical improvement (4.6±2.7 VAS pain; p<0.00001), a radiological progression was observed in 15/31 patients (48%). An increase in the fracture severity (2.0±0.6; p=0.0014) and 10 new vertebral fractures (2.1±1.3 fractures per patient; p=0.07) were observed.
No differences were found in age, FRAX, BMD, 25(OH) D and PTH between patients with radiological progression and patients with stable fracture. Patients with radiological progression had fewer vertebral fractures (1.4±0.8 vs 2.0±1.0), lower severity (1.3±0.6 vs 2.4±2.8) and worse pain control (5.5±2.8 vs 4.1±2.5), although differences were not significant.
Conclusions Half acute clinical vertebral fracture patients will have a radiological progression in the following weeks. Patients with a single, mild-moderate vertebral fracture, without clinical improvement would have to be assessed for radiological progression.
Disclosure of Interest None declared