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. 2023 Sep;34(9):1561-1575.
doi: 10.1007/s00198-023-06796-6. Epub 2023 May 26.

Mortality among older adults with osteoporotic vertebral fracture

Laura S Gold  1   2 , Pradeep Suri  3   4 , Michael K O'Reilly  5 , David F Kallmes  6 , Patrick J Heagerty  3   7 , Jeffrey G Jarvik  8   3
Affiliations

Mortality among older adults with osteoporotic vertebral fracture

Laura S Gold et al. Osteoporos Int. 2023 Sep.

Abstract

We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving kyphoplasty were at reduced risk of death but after matching on age and medical complications, patients who received kyphoplasty were at increased risk of death.

Purpose: In previous observational studies, kyphoplasty for treatment of osteoporotic vertebral fractures has been associated with decreased mortality compared to conservative management. The purpose of this research was to determine whether older adults who received kyphoplasty had reduced risk of mortality compared to matched patients who did not.

Methods: Retrospective cohort study of US Medicare enrollees with osteoporotic vertebral fractures between 2017-2019 comparing patients who underwent kyphoplasty to those who did not. We identified 2 control groups a priori: 1) non-augmented patients who met inclusion criteria (group 1); 2) propensity-matched patients on demographic and clinical variables (group 2). We then identified additional control groups using matching for medical complications (group 3) and age + comorbidities (group 4). We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with mortality.

Results: A total of 235,317 patients (mean (± standard deviation) age 81.1 ± 8.3 years; 85.8% female) were analyzed. In the primary analyses, those who received kyphoplasty were at reduced risk of death compared to those who did not: adjusted HR (95% CI) in group 1 = 0.84 (0.82, 0.87); and in group 2 = 0.88 (0.85, 0.91). However, in post hoc analyses, patients who received kyphoplasty were at increased risk of death: adjusted HR (95% CI) in group 3 = 1.32 (1.25, 1.41) and 1.81 (1.58, 2.09) in group 4.

Conclusion: An apparent benefit of kyphoplasty on mortality among patients with vertebral fractures was not present after rigorous propensity matching, illustrating the importance of comparing similar individuals when evaluating observational data.

Keywords: Kyphoplasty; Mortality; Osteoporosis; Propensity score; Spine.

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Conflict of interest statement

Drs. Gold, Suri, O’Reilly, and Heagerty do not have competing interests. David F. Kalmes discloses that he has ownership/stock in Kypheze, LLC; patents involved in spine augmentation; and has received research support and royalties from Medtronic. Dr. Jeffrey G Jarvik reports royalties as a book co-editor from Springer Publishing and travel reimbursement for Faculty Board of Review from GE-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF) and royalties as a chapter author from Wolters Kluwer/UpToDate.

Figures

Fig. 1
Fig. 1
Flow of participants in analysis
Fig. 2
Fig. 2
a-d Kaplan Meier curves comparing mortality among patients who received kyphoplasty to those who did not among 4 different matched groups
See this image and copyright information in PMC

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