Top

Osteoporosis International

Published in:

01-11-2018 | Original Article

A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese

Authors: L.-J. Song, L.-L. Wang, L. Ning, S.-W. Fan, X. Zhao, Y.-L. Chen, Z.-Z. Li, Z.-A. Hu

Published in: Osteoporosis International | Issue 11/2018

Abstract

Summary

This study described a modified quantitative morphometry (mQM) system adapted to specific reference values for Mainland Chinese population. The mQM system is validated using the Genant Semiquantative system and is sensitive for detecting vertebral height changes and predicting cement leakage after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compressive fracture (OVCF).

Introduction

OVCF is a manifestation of osteoporosis. To improve clinical management of osteoporosis, the quantitative morphometry (QM) system has been widely used for the early diagnosis and precise classification of OVCF in developed countries. Here, we present an mQM system and validated its use in detecting OVCF in Mainland Chinese.

Methods

Using our mQM system, the pre- and post-operative values of vertebral heights were measured and evaluated in 309 Mainland Chinese who received percutaneous kyphoplasty (PKP) as OVCF treatment. Measurements and classification of fractures from the mQM system were validated by comparing to values obtained by the Genant semiquantative (SQ) method. Moreover, we evaluated the sensitivity of the mQM system by its ability to detect restoration of vertebral heights and predict cement leakage after PKP.

Results

The five classification of fractures, No deformity (ND), anterior wedge (AW), posterior wedge (PW), biconcavity (BC), and compression (CP), evaluated by the mQM method shared similar distribution characteristics compared to those obtained by the SQ method. In addition, mQM evaluation showed that the vertebra height of all fracture types showed significant restoration after PKP. The incidence of cement leakage was most common in CP (37.5%), followed by AW (31.6%), BC (26.5%), ND (23.7%), and PW (0.0%).

Conclusions

Our mQM system is suitable for classification of fractures, detection of vertebral height restoration, and correlation of cement leakage after PKP in Mainland Chinese population.

Nayak S, Greenspan SL (2016) Cost-effectiveness of osteoporosis screening strategies for men. J Bone Miner Res 31(6):1189–1199. https://doi.org/10.1002/jbmr.2784 CrossRefPubMedPubMedCentral

Schousboe JT (2016) Epidemiology of vertebral fractures. J Clin Densitom 19(1):8–22. https://doi.org/10.1016/j.jocd.2015.08.004 CrossRefPubMed

Zeytinoglu M, Jain RK, Vokes TJ (2017) Vertebral fracture assessment: enhancing the diagnosis, prevention, and treatment of osteoporosis. Bone 104:54–65. https://doi.org/10.1016/j.bone.2017.03.004 CrossRefPubMed

Pinheiro MM, Reis Neto ET, Machado FS et al. (2010) Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women. Rev Saude Publica 44 (3):479–485CrossRef

Klotzbuecher CM, Ross PD, Landsman PB et al. (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15 (4):721–739. https://doi.org/10.1359/jbmr.2000.15.4.721 CrossRef

Postacchini R, Paolino M, Faraglia S et al. (2013) Assessment of patient’s pain-related behavior at physical examination may allow diagnosis of recent osteoporotic vertebral fracture. Spine J 13 (9):1126–1133. https://doi.org/10.1016/j.spinee.2013.07.427 CrossRef

Clark EM, Gooberman-Hill R, Peters TJ (2016) Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes. Osteoporos Int 27(4):1459–1467. https://doi.org/10.1007/s00198-015-3397-2 CrossRefPubMed

Upadhye S, Kumbhare D (2016) What are the most useful red flags for suspected vertebral fracture in patients with low back pain in the emergency department? Ann Emerg Med 67(1):81–82. https://doi.org/10.1016/j.annemergmed.2015.04.026 CrossRefPubMed

Freitas SS, Barrett-Connor E, Ensrud KE et al. (2008) Rate and circumstances of clinical vertebral fractures in older men. Osteoporos Int 19 (5):615–623. https://doi.org/10.1007/s00198-007-0510-1 CrossRef

10.

Huang Z, Zhang L (2012) Treatment of osteoporotic vertebral compressive fractures with percutaneous kyphoplasty and oral Zishengukang. J Tradit Chin Med 32(4):561–564CrossRef

11.

Masala S, Cesaroni A, Sergiacomi G et al. (2004) Percutaneous kyphoplasty: new treatment for painful vertebral body fractures. In Vivo 18 (2):149–153

12.

Yimin Y, Zhiwei R, Wei M et al. (2013) Current status of percutaneous vertebroplasty and percutaneous kyphoplasty—a review. Med Sci Monit 19:826–836. https://doi.org/10.12659/MSM.889479 CrossRef

13.

Hoashi JS, Thomas SM, Goodwin RC et al. (2016) Balloon kyphoplasty for managing intractable pain in pediatric pathologic vertebral fractures. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000000886 CrossRef

14.

Noldge G, DaFonseca K, Grafe I et al. (2006) [Balloon kyphoplasty in the treatment of back pain]. Radiologe 46 (6):506–512. https://doi.org/10.1007/s00117-006-1384-5 CrossRef

15.

Riesner HJ, Kiupel K, Lang P et al. (2016) Clinical relevance of cement leakage after radiofrequency kyphoplasty vs. balloon kyphoplasty: a prospective randomised study. Z Orthop Unfall 154 (4):370–376. https://doi.org/10.1055/s-0042-104069 CrossRef

16.

Genant HK, Jergas M, Palermo L et al. (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis the study of osteoporotic fractures research group. J Bone Miner Res 11 (7):984–996. https://doi.org/10.1002/jbmr.5650110716 CrossRef

17.

Ferrar L, Jiang G, Adams J et al. (2005) Identification of vertebral fractures: an update. Osteoporos Int 16 (7):717–728. https://doi.org/10.1007/s00198-005-1880-x CrossRef

18.

Eastell R, Cedel SL, Wahner HW et al. (1991) Classification of vertebral fractures. J Bone Miner Res 6 (3):207–215. https://doi.org/10.1002/jbmr.5650060302 CrossRef

19.

McCloskey EV, Spector TD, Eyres KS et al. (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3 (3):138–147CrossRef

20.

Smith-Bindman R, Cummings SR, Steiger P et al. (1991) A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 6 (1):25–34. https://doi.org/10.1002/jbmr.5650060106 CrossRef

21.

Ning L, Song LJ, Fan SW et al. (2017) Vertebral heights and ratios are not only race-specific, but also gender- and region-specific: establishment of reference values for mainland Chinese. Arch Osteoporos 12 (1):88. https://doi.org/10.1007/s11657-017-0383-7

22.

Yan L, He B, Guo H et al. (2016) The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int 27 (5):1849–1855. https://doi.org/10.1007/s00198-015-3430-5 CrossRef

23.

Tome-Bermejo F, Pinera AR, Duran-Alvarez C et al. (2014) Identification of risk factors for the occurrence of cement leakage during percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000000294, 39, E700CrossRef

24.

Grados F, Fechtenbaum J, Flipon E et al. (2009) Radiographic methods for evaluating osteoporotic vertebral fractures. Joint Bone Spine 76 (3):241–247. https://doi.org/10.1016/j.jbspin.2008.07.017 CrossRef

25.

Genant HK, Wu CY, van Kuijk C et al. (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8 (9):1137–1148. https://doi.org/10.1002/jbmr.5650080915 CrossRef

26.

Black DM, Reiss TF, Nevitt MC et al. (1993) Design of the fracture intervention trial. Osteoporos Int 3 Suppl 3:S29–S39CrossRef

27.

Harris ST, Watts NB, Genant HK et al. (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) study group. JAMA 282 (14):1344–1352

28.

Siris E, Adachi JD, Lu Y et al. (2002) Effects of raloxifene on fracture severity in postmenopausal women with osteoporosis: results from the MORE study. Multiple Outcomes of Raloxifene Evaluation Osteoporos Int 13 (11):907–913. https://doi.org/10.1007/s001980200125 CrossRef

29.

Yang H, Pan J, Wang G (2014) A review of osteoporotic vertebral fracture nonunion management. Spine (Phila Pa 1976) 39 (26 Spec No.):B4–B6. https://doi.org/10.1097/BRS.0000000000000538 CrossRef

30.

El Maghraoui A, Sadni S, El Maataoui A et al. (2015) Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women. Nutr Metab (Lond) 12:44. https://doi.org/10.1186/s12986-015-0041-2

31.

Greene DL, Isaac R, Neuwirth M et al. (2007) The eggshell technique for prevention of cement leakage during kyphoplasty. J Spinal Disord Tech 20 (3):229–232. https://doi.org/10.1097/01.bsd.0000211276.76024.30 CrossRef

32.

Uri IF, Garnon J, Tsoumakidou G et al. (2015) An ice block: a novel technique of successful prevention of cement leakage using an ice ball. Cardiovasc Intervent Radiol 38 (2):470–474. https://doi.org/10.1007/s00270-014-0991-1 CrossRef

33.

Corcos G, Dbjay J, Mastier C et al. (2014) Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine (Phila Pa 1976) 39 (5):E332–E338. https://doi.org/10.1097/BRS.0000000000000134 CrossRef

34.

Wang C, Fan S, Liu J et al. (2014) Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J 14 (8):1551–1558. https://doi.org/10.1016/j.spinee.2013.09.025 CrossRef

35.

Zhu SY, Zhong ZM, Wu Q et al. (2016) Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop 40 (6):1205–1210. https://doi.org/10.1007/s00264-015-3102-2 CrossRef

36.

Ruiz Santiago F, Tomas Munoz P, Moya Sanchez E et al. (2016) Classifying thoracolumbar fractures: role of quantitative imaging. Quant Imaging Med Surg 6 (6):772–784. https://doi.org/10.21037/qims.2016.12.04 CrossRef

Title: A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese
Authors: L.-J. Song
L.-L. Wang
L. Ning
S.-W. Fan
X. Zhao
Y.-L. Chen
Z.-Z. Li
Z.-A. Hu
Publication date: 01-11-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 11/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4641-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2018

Build better bones with exercise (B3E pilot trial): results of a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in older women with vertebral fracture

Role of musculoskeletal disorders in falls of postmenopausal women

Decreasing trend of bone mineral density in US multiethnic population: analysis of continuous NHANES 2005–2014

Medication persistence and risk of fracture among female Medicare beneficiaries diagnosed with osteoporosis

Monocytes from male patients with ankylosing spondylitis display decreased osteoclastogenesis and decreased RANKL/OPG ratio

VITamin D and OmegA-3 TriaL (VITAL) bone health ancillary study: clinical factors associated with trabecular bone score in women and men