Fracture severity dependence of bone and muscle performance in patients following single or multiple vertebral fractures

Abstract

Background: Few studies focus on the clinical, laboratory, radiological, and biological characteristics of bone and muscle of multiple vertebral fractures, which are associated with a more poor prognosis compared with single fracture.

Purpose: To compare the BMD, bone turnover, muscularity, fatty infiltration of muscle, and prevalence of co-morbidities in patients with single and multiple vertebral fractures.

Methods: We recruited 100 patients with single fracture (age 66.96 ± 8.24 years) and 100 with multiple fractures (age 69.90 ± 7.80 years); performed dual-energy X-ray absorptiometry of the femoral neck, hip, and lumbar vertebrae; and measured biochemical markers of bone turnover, muscularity, and fatty infiltration.

Results: Patients with multiple vertebral fractures had lower hip BMD (p=0.010) than those with single fractures, but there was no difference in femoral neck and lumbar vertebral BMD nor in muscularity. However, fatty infiltration, an indicator of muscle quality, was significantly higher in participants with multiple fractures (p=0.006). Diabetes was significantly more common in patients with multiple fractures (p=0.042). There were no significant differences in markers of bone turnover, and Seperman analyses showed no correlations of CTX-1 or tPINP with the BMD of the hip, femoral neck, or lumbar spine. However, high CTX-1 was associated with high tPINP (r=0.4805; p<0.0001), and marked fatty infiltration was associated with low hip, lumbar vertebral, and femoral neck BMD. Cox regression analyses showed that age (OR 1.057; 95% CI 1.016-1.101; p=0.006) and low hip BMD (OR 0.016; 95% CI, 0.000-0.549; p=0.022) were associated with a higher risk of multiple fractures.

Conclusion: Patients with multiple fractures tend to have lower hip BMD, a history of type 2 diabetes, and more substantial fatty infiltration of muscle than in those with single fractures. Age and hip BMD rather than lumbar vertebrae BMD were found to be independent risk factors for multiple vertebral compression fractures, implying that hip BMD may be a more sensitive predictor for multiple vertebral fractures. More improvements in hip BMD and focus on older persons may be useful means of preventing multiple fractures.

Keywords: bone; multiple fractures; muscle; osteoporosis; vertebral fracture.

Figure 1

Flow diagram of the study sample.

Figure 2

Bone mineral density of the hip (A), femoral neck (B), and lumbar vertebrae (C) in the single vertebral fracture and multiple vertebral fracture groups. P-values were calculated using the independent samples t-test. NS indicates that P > 0.05, which means there is no statistical significance between the groups.

Figure 3

Relationships of CTX and tPINP with the BMD of the lumbar vertebrae and femoral neck Correlations of the serum CTX and tPINP concentrations with the BMD of the lumbar spine and femoral neck are shown. BMD, bone mineral density; β-CTX, β-isomerized C-terminal telopeptides; tPINP, total procollagen type I propeptides.

Figure 4

Results of the binary logistic regression analysis to identify factors potentially influencing the risk of multiple fractures (A–G). BMD, bone mineral density; β-CTX, β-isomerized C-terminal telopeptides; tPINP, total procollagen type I propeptides; OCN, osteocalcin; VitD, vitamin D; PTH, parathyroid hormone.

Figure 5

Comparison of the muscle mass and fatty infiltration of participants in the single and multiple fracture groups (A, B). Representative graphs of the fatty infiltration of muscle in participants in the single and multiple fracture groups. (C, D). Quantification of muscle mass and fatty infiltration in the two groups. (E–G). Correlation analysis of the relationships of fatty infiltration with the bone mineral density of the hip, lumbar vertebrae, and femoral neck. NS indicates that P > 0.05, which means there is no statistical significance between the groups.