Skip to main content
Top
Published in: Osteoporosis International 2/2017

01-02-2017 | Original Article

Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study

Authors: S. Takahashi, M. Hoshino, K. Takayama, K. Iseki, R. Sasaoka, T. Tsujio, H. Yasuda, T. Sasaki, F. Kanematsu, H. Kono, H. Toyoda, H. Nakamura

Published in: Osteoporosis International | Issue 2/2017

Login to get access

Abstract

Summary

This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures.

Introduction

Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification.

Methods

This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured.

Results

The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion.

Conclusions

MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.
Literature
1.
3.
go back to reference Pfirrmann CW, Metzdorf a, Zanetti M, et al. (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878CrossRef Pfirrmann CW, Metzdorf a, Zanetti M, et al. (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878CrossRef
4.
go back to reference Krege JH, Siminoski K, Adachi JD, et al. (2006) A simple method for determining the probability a new vertebral fracture is present in postmenopausal women with osteoporosis. Osteoporos Int 17:379–386CrossRefPubMed Krege JH, Siminoski K, Adachi JD, et al. (2006) A simple method for determining the probability a new vertebral fracture is present in postmenopausal women with osteoporosis. Osteoporos Int 17:379–386CrossRefPubMed
5.
go back to reference Huang C, Ross PD, Wasnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475CrossRefPubMed Huang C, Ross PD, Wasnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475CrossRefPubMed
6.
go back to reference Kado DM, Browner WS, Palermo L, et al. (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220CrossRefPubMed Kado DM, Browner WS, Palermo L, et al. (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220CrossRefPubMed
7.
go back to reference Nevitt MC, Ettinger B, Black DM, et al. (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800CrossRefPubMed Nevitt MC, Ettinger B, Black DM, et al. (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800CrossRefPubMed
8.
go back to reference Lenchik L, Rogers LF, Delmas PD, Genant HK (2004) Diagnosis of osteoporotic vertebral fractures. Am J Roentgenol 183:949–958CrossRef Lenchik L, Rogers LF, Delmas PD, Genant HK (2004) Diagnosis of osteoporotic vertebral fractures. Am J Roentgenol 183:949–958CrossRef
9.
go back to reference Toyone T, Toyone T, Tanaka T, et al. (2006) Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 31:2963–2966CrossRef Toyone T, Toyone T, Tanaka T, et al. (2006) Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 31:2963–2966CrossRef
10.
go back to reference McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum 48:1414–1419CrossRefPubMed McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum 48:1414–1419CrossRefPubMed
11.
go back to reference Mehta JS, Reed MR, McVie JL, Sanderson PL (2004) Weight-bearing radiographs in thoracolumbar fractures: do they influence management? Spine (Phila Pa 1976) 29:564–567CrossRef Mehta JS, Reed MR, McVie JL, Sanderson PL (2004) Weight-bearing radiographs in thoracolumbar fractures: do they influence management? Spine (Phila Pa 1976) 29:564–567CrossRef
12.
go back to reference Oner FC, Van Gils APG, Dhert WJ a, Verbout a J (1999) MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skelet Radiol 28:433–443CrossRef Oner FC, Van Gils APG, Dhert WJ a, Verbout a J (1999) MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skelet Radiol 28:433–443CrossRef
13.
go back to reference Cho T, Matsuda M, Sakurai M (1996) MRI findings on healing process of vertebral fracture in osteoporosis. J Orthop Sci 1:16–33CrossRef Cho T, Matsuda M, Sakurai M (1996) MRI findings on healing process of vertebral fracture in osteoporosis. J Orthop Sci 1:16–33CrossRef
14.
go back to reference Kanchiku T, Imajo Y, Suzuki H, et al. (2013) Usefulness of an early MRI-based classification system for predicting vertebral collapse and pseudoarthrosis after osteoporotic vertebral fractures. J Spinal Disord Tech 27:61–65CrossRef Kanchiku T, Imajo Y, Suzuki H, et al. (2013) Usefulness of an early MRI-based classification system for predicting vertebral collapse and pseudoarthrosis after osteoporotic vertebral fractures. J Spinal Disord Tech 27:61–65CrossRef
15.
go back to reference Tsujio T, Nakamura H, Terai H, et al. (2011) Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion: a prospective multicenter study. Spine (Phila Pa 1976) 36:1229–1235CrossRef Tsujio T, Nakamura H, Terai H, et al. (2011) Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion: a prospective multicenter study. Spine (Phila Pa 1976) 36:1229–1235CrossRef
16.
go back to reference Heini PF (2005) The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int 16(Suppl 2):S85–S92CrossRefPubMed Heini PF (2005) The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int 16(Suppl 2):S85–S92CrossRefPubMed
17.
go back to reference McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18:24–29CrossRefPubMed McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18:24–29CrossRefPubMed
18.
go back to reference Daniel A, Sven KT, Von Der HN, et al. (2014) Non-union of osteoporotic vertebral fractures—identification and treatment of an underestimated pathology in elderly patients with persistent back pain. Acta Orthop Belg 80:444–450 Daniel A, Sven KT, Von Der HN, et al. (2014) Non-union of osteoporotic vertebral fractures—identification and treatment of an underestimated pathology in elderly patients with persistent back pain. Acta Orthop Belg 80:444–450
19.
go back to reference Baker LL, Goodman SB, Perkash I, et al. (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging. Radiology 174:495–502CrossRefPubMed Baker LL, Goodman SB, Perkash I, et al. (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging. Radiology 174:495–502CrossRefPubMed
20.
go back to reference Meyers SP, Wiener SN (1991) Magnetic resonance imaging features of fractures using the short tau inversion recovery (STIR) sequence: correlation with radiographic findings. Skelet Radiol 20:499–507CrossRef Meyers SP, Wiener SN (1991) Magnetic resonance imaging features of fractures using the short tau inversion recovery (STIR) sequence: correlation with radiographic findings. Skelet Radiol 20:499–507CrossRef
21.
go back to reference Kim H-J, Yi J-M, Cho H-G, et al. (2014) Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am 96:1959–1966CrossRefPubMed Kim H-J, Yi J-M, Cho H-G, et al. (2014) Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am 96:1959–1966CrossRefPubMed
22.
go back to reference Goodwin VA, Hall AJ, Rogers E, Bethel A (2016) Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ Open Goodwin VA, Hall AJ, Rogers E, Bethel A (2016) Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ Open
23.
go back to reference Oner F, Ramos L, Simmermacher R, et al. (2002) Classification of thoracic and lumbar spine fractures: problems of reproducibility: a study of 53 patients using CT and MRI. Eur Spine J 11:235–245CrossRefPubMedPubMedCentral Oner F, Ramos L, Simmermacher R, et al. (2002) Classification of thoracic and lumbar spine fractures: problems of reproducibility: a study of 53 patients using CT and MRI. Eur Spine J 11:235–245CrossRefPubMedPubMedCentral
24.
go back to reference Kanchiku T, Taguchi T, Kawai S (2003) Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fracture. J Orthop 8:463–466 Kanchiku T, Taguchi T, Kawai S (2003) Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fracture. J Orthop 8:463–466
25.
go back to reference Yao L, Lee JK (1988) Occult intraosseous fracture: detection with MR imaging. Radiology 167:749–751CrossRefPubMed Yao L, Lee JK (1988) Occult intraosseous fracture: detection with MR imaging. Radiology 167:749–751CrossRefPubMed
26.
go back to reference Deutsch AL, Mink JH (1989) Magnetic resonance imaging of musculoskeletal injuries. Radiol Clin N Am 27:983–1002PubMed Deutsch AL, Mink JH (1989) Magnetic resonance imaging of musculoskeletal injuries. Radiol Clin N Am 27:983–1002PubMed
28.
go back to reference Smith SR, Williams CE, Davies JM, Edwards RH (1989) Bone marrow disorders: characterization with quantitative MR imaging. Radiology 172:805–810CrossRefPubMed Smith SR, Williams CE, Davies JM, Edwards RH (1989) Bone marrow disorders: characterization with quantitative MR imaging. Radiology 172:805–810CrossRefPubMed
29.
go back to reference Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840CrossRefPubMed Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840CrossRefPubMed
30.
go back to reference Dunn AJ, Campbell RSD, Mayor PE, Rees D (2008) Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skelet Radiol 37:443–450CrossRef Dunn AJ, Campbell RSD, Mayor PE, Rees D (2008) Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skelet Radiol 37:443–450CrossRef
31.
go back to reference Mcnally EG, Goodman R, Burge P (2000) Original article the role of MRI in the assessment of scaphoid fracture healing : a pilot study. Eur Radiol 1928:1926–1928CrossRef Mcnally EG, Goodman R, Burge P (2000) Original article the role of MRI in the assessment of scaphoid fracture healing : a pilot study. Eur Radiol 1928:1926–1928CrossRef
32.
go back to reference Ryu CW, Han H, Lee YM, Lim MK (2009) The intravertebral cleft in benign vertebral compression fracture: the diagnostic performance of non-enhanced MRI and fat-suppressed contrast-enhanced MRI. Br J Radiol 82:976–981CrossRefPubMedPubMedCentral Ryu CW, Han H, Lee YM, Lim MK (2009) The intravertebral cleft in benign vertebral compression fracture: the diagnostic performance of non-enhanced MRI and fat-suppressed contrast-enhanced MRI. Br J Radiol 82:976–981CrossRefPubMedPubMedCentral
34.
go back to reference Malghem J, Maldague B, Labaisse MA, et al. (1993) Intravertebral vacuum cleft: changes in content after supine positioning. Radiology 187:483–487CrossRefPubMed Malghem J, Maldague B, Labaisse MA, et al. (1993) Intravertebral vacuum cleft: changes in content after supine positioning. Radiology 187:483–487CrossRefPubMed
35.
go back to reference Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel B, et al. (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124CrossRefPubMed Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel B, et al. (2007) Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 56:1118–1124CrossRefPubMed
36.
go back to reference Mahnken AH, Wildberger JE, Adam G, et al. (2005) Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short τ inversion recovery imaging? Eur Radiol 15:1387–1392CrossRefPubMed Mahnken AH, Wildberger JE, Adam G, et al. (2005) Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short τ inversion recovery imaging? Eur Radiol 15:1387–1392CrossRefPubMed
37.
go back to reference Diamond TH, Clark WA, Kumar SV (2007) Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures. Bone 40:775–780CrossRefPubMed Diamond TH, Clark WA, Kumar SV (2007) Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures. Bone 40:775–780CrossRefPubMed
38.
go back to reference Bailey CS, Urquhart JC, Dvorak MF, et al. (2014) Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J 14:2557–2564CrossRefPubMed Bailey CS, Urquhart JC, Dvorak MF, et al. (2014) Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J 14:2557–2564CrossRefPubMed
39.
go back to reference Shamji MF, Roffey DM, Young DK, et al. (2014) A pilot evaluation of the role of bracing in stable thoracolumbar burst fractures without neurological deficit. J Spinal Disord Tech 27:370–375CrossRefPubMed Shamji MF, Roffey DM, Young DK, et al. (2014) A pilot evaluation of the role of bracing in stable thoracolumbar burst fractures without neurological deficit. J Spinal Disord Tech 27:370–375CrossRefPubMed
40.
go back to reference Hoshino M, Tsujio T, Terai H, et al. (2013) Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976) 38:E641–E648CrossRef Hoshino M, Tsujio T, Terai H, et al. (2013) Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976) 38:E641–E648CrossRef
Metadata
Title
Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study
Authors
S. Takahashi
M. Hoshino
K. Takayama
K. Iseki
R. Sasaoka
T. Tsujio
H. Yasuda
T. Sasaki
F. Kanematsu
H. Kono
H. Toyoda
H. Nakamura
Publication date
01-02-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 2/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-016-3737-x

Other articles of this Issue 2/2017

Osteoporosis International 2/2017 Go to the issue