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. 2022 Mar;12(2):289-297.
doi: 10.1177/2192568220982279. Epub 2021 Feb 5.

Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review

Max J Scheyerer  1 , Ulrich J A Spiegl  2 , Sebastian Grueninger  3 , Frank Hartmann  4 , Sebastian Katscher  5 , Georg Osterhoff  6 , Mario Perl  7 , Matthias Pumberger  8 , Gregor Schmeiser  9 , Bernhard W Ullrich  10 , Klaus J Schnake  11   12
Affiliations

Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review

Max J Scheyerer et al. Global Spine J. 2022 Mar.

Abstract

Study design: Systematic review.

Objectives: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure.

Methods: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm.

Results: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <-2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated.

Conclusion: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

Keywords: compression fracture; osteoporotic fracture; risk factor; treatment failure.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow chart.
Figure 2.
Figure 2.
Fracture types with high rates of failure.-
Figure 3.
Figure 3.
Intravertebral cleft with consecutive spinal instability illustrated with a comparison of the supine position (CT and MRT) to the standing position.
See this image and copyright information in PMC

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