Comparison of acute single versus multiple osteoporotic vertebral compression fractures in radiographic characteristic and bone fragility

Abstract

Background: Osteoporotic vertebral compression fractures (OVCF) are common in aged population with bone fragility. This study aimed to identify the radiographic and bone fragility characteristic of acute single and multiple OVCF.

Methods: OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, bone mineral density, spine trauma, duration of pre-hospital back pain, anatomical location and distribution pattern of OVCF, extent of vertebral marrow edema, and degree of vertebral compression of patients with multi-segment vertebral fractures (MSVF) were summarized and compared to those with single segment vertebral fractures (SSVF).

Results: A total of 1182 patients with 1530 acute fractured vertebrae were included. There were 944 SSVF (79.9%) and 238 MSVF (20.1%) simultaneously involving two (MSVF-2) or three and more vertebra (MSVF-3/m). The Female-Male ratio was 4.4 and differed not significantly between SSVF and MSVF. Females in SSVF were younger than males while MSVF-2 tended to occur in older females. L1, T12, and L2 were the three most frequently fractured vertebra and MSVF involved more vertebra in thoracic and lumbar spine. 31.1% in MSVF-2 and 83.1% in MSVF-3/m had at least two vertebral fractures in adjacent. The fractured thoracolumbar vertebra in MSVF was less compressed than that in SSVF. Apparent spine trauma was reported by 61.4% of SSVF, 44.1% of MSVF-2, and 36.3% of MSVF-3/m, while early hospitalization with pre-hospital back pain ≤ 1 week was 58.9% in SSVF, 45.3% in MSVF-2, and 25.9% in MSVF-3/m. Only females aged 70-80 years old in MSVF-3/m showed lower baseline bone mineral density than in MSVF-2 and SSVF. MSVF were not associated with increased comorbidity of hypertension, diabetes, coronary heart disease, cerebral infarction, and chronic pulmonary disease.

Conclusions: 20% of acute OVCF can involve multiple vertebra without significant spine trauma or lower baseline bone mineral density. Multiple OVCF tend to occur in adjacent vertebra with less thoracolumbar vertebral compression but longer duration of pre-hospital back pain.

Keywords: Fragility fracture; Multiple fracture; Osteoporosis; Osteoporotic vertebral compression fracture; Vertebral fracture cascades.

Fig. 1

Radiographic characteristics of single and multiple osteoporotic vertebral compression fractures. The sagittal T2-weighted fat suppression MR imaging of single (a–c) and multiple (d–f) vertebral compression fractures. a A 78-year-old male complaining back pain for 5 days after fell on ground showed vertebral bone marrow edema in the cranial half of L1 vertebrae. The anterior and posterior height (red line) of fractured vertebrae was measured to quantify the degree of vertebral compression. b A 79-year-old female without spine trauma complained back pain for 1 week and showed diffused type of vertebral bone marrow edema in L1. c A 66-year-old female complained back pain for 4 days after heavy lift injury showed vertebral bone marrow edema in the caudal half of L3. d Two acute vertebral compression fractures in adjacent (T12 and L1) were detected in a 81-year-old male complaining back pain for 1 month without spine trauma. e Two acute vertebral compression fractures (L1 and L3) intermittent with one intact vertebrae (L2) were detected in a 74-year-old female complaining back pain for 1 month without spine trauma. f Four acute vertebral compression fractures (T8, T11, T12, and L1) with three in adjacent were detected in a 81-year-old female complaining back pain for 2 weeks without spine trauma

Fig. 2

Distribution of single and multiple osteoporotic vertebral compression fractures. The 1530 fractured vertebrae from 1182 patients were unevenly located into thoracic (T1–T9), thoracolumbar (T10–L2), and lumbar (L3–L5) spine. L1, T12, and L2 were the three most frequently fractured vertebra in both single and multiple osteoporotic vertebral compression fractures. Multiple osteoporotic vertebral compression fractures involved more vertebra in lumbar and thoracic spine

Fig. 3

Degree of vertebral compression in single and multiple osteoporotic vertebral compression fractures. The ratio of anterior and posterior height of fractured thoracic, thoracolumbar, and lumbar vertebra. Thoracolumbar vertebra in MSVF-2 and MSVF-3/m showed significantly higher ratio of anterior and posterior vertebral height than in SSVF. SSVF: single segment vertebral fracture; MSVF-2: multi-segment vertebral fractures involving two vertebra; MSVF-3/m: multi-segment vertebral fractures involving three or more vertebra. ns: not significantly different; *p < 0.05; **p < 0.01

Fig. 4

Bone mineral density of females with single and multiple osteoporotic vertebral compression fractures. The T-score values from dual-energy X-ray absorptiometry of lumbar spine and hip joint in 387 females with osteoporotic vertebral compression fractures. In the age group of 70–80 years old, MSVF-3/m showed significantly lower T-score values than MSVF-2 and SSVF. SSVF: single segment vertebral fracture; MSVF-2: multi-segment vertebral fractures involving two vertebra; MSVF-3/m: multi-segment vertebral fractures involving three or more vertebra. ns: not significantly different; *p < 0.05; **p < 0.01