Recurrent and new vertebral fractures after vertebroplasty for osteoporotic vertebral fractures
We 1 retrospectively analyzed 421 patients who came to our department for vertebroplasty for painful vertebral fractures. 356 patients (283 women, 73 men) obtained follow-up data for a total of 434 vertebral data, of which 35 patients developed postoperative recurrent vertebral fractures. The 35 patients were divided into a recurrent fracture group and the other 321 patients were in the no fracture group. These 35 recurrent fractures were again grouped into an adjacent vertebral fracture group and a non-adjacent vertebral fracture group.
There were significant differences in bone mineral density and gender between the recurrent fracture group and the no-fracture group. The mean BMD T value in the recurrent fracture group was -3.95±0.59 compared with -2.86±0.55 in the no-fracture group (P<0.01). There were 33 women (94.29%) in the recurrent fracture group compared to 250 women (77.88%) in the no fracture group.
Figure A1 shows: T11,L2 fracture, recurrent T8 fracture
Figure B1 shows: T9,T11 fractures, recurrent T10 fractures
We conclude that female patients and low bone density are the main risk factors for postoperative recurrent vertebral fractures.
Osteo-porotic vertebral compression fractures (OVCFs) are reported to occur in approximately 1.4 million people each year.2 Percutaneous vertebroplasty (PVP) has been shown to be less invasive, provides rapid pain relief, and is more effective in reducing pain. However, postoperative recurrence of OVCFs, infection, nerve root injury, pulmonary embolism, and cement leakage are also complications after vertebroplasty.4 Postoperative recurrence of OVCFs is a serious threat to patients’ physical and mental health and affects their lives. They are a serious threat to the physical and mental health of patients, and affect their quality of Life, as well as bring great economic pressure to families and society.
Anti-osteoporotic drugs are of great importance in The prevention of recurrent OVCFs
The lower the BMD, the higher the risk of recurrent OVCFs after PVP, and therefore, the use of anti-osteoporosis drugs to improve BMD can effectively prevent the occurrence of recurrent OVCFs after surgery.4 A META analysis6 was performed by searching the data from June 2015 to June 2019 including MEDLINE, EMBASE, Central and Web A META analysis6 examined the effectiveness of various drugs in preventing the development of OVCFs by searching randomized controlled trials from June 2015 to June 2019 from databases including MEDLINE, EMBASE, Central, and WebofScience, suggesting that the use of anti-osteoporosis drugs may reduce the risk of recurrent OVCFs.6 The currently available anti-osteoporosis drugs are listed in the table below, of which those that rapidly and effectively The current antiosteoporosis drugs available are listed in the table below, of which those that can rapidly and effectively increase bone mineral density may be preferable for post-operative PVP patients 7.
The RANKL inhibitor denosumab, a human RANKL monoclonal antibody with potent anti-osteoporotic effects, has a high affinity for endogenous RANKL in humans and effectively inhibits osteoclast formation and activation in humans, improving cortical and cancellous bone strength in patients with osteoporosis.8 In the META analysis mentioned above,6 high quality evidence confirmed that denosumab is a potent anti-osteoporosis drug. In the META analysis mentioned above,6 high-quality evidence confirmed the effectiveness of disulfiramab in reducing the risk of recurrent OVCFs (RR=0.41; 95% CI,0.29-0.57; P<0.0001).
In the FREEDOM study,9 in which 7,868 women with T values <-2.5 and ≥-4.0 in the lumbar spine or total hip were enrolled, 1 month of treatment with disulfiramab reduced bone resorption by 86%; at 3 years of treatment, disulfiramab treatment caused a 9.2% relative increase in bone mineral density in the lumbar spine compared with placebo; and at 3 years of treatment, disulfiramab treatment caused a 9.2% relative increase in bone mineral density in the lumbar spine compared with placebo. The relative increase in lumbar spine BMD was 9.2% at 3 years of treatment compared to placebo, and 21.7% at 10 years of treatment compared to placebo10.
The risk of vertebral fracture was also significantly reduced by 61% in the first year of treatment compared with placebo; the overall risk was reduced by 68% over 3 years of treatment.9 The risk of new vertebral fracture remained low in the FREEDOM extension study.10
Disulfiramab is administered by subcutaneous injection at any Time of day, is not affected by diet, does not require hydration, and patients do not need mandatory hydration prior to treatment. Some studies have shown that subcutaneous injectable agents (containing disulfiramab) have a more pronounced effect on reducing the rate of reoperation after PVP or vertebroplasty compared with oral bisphosphonates (calibrated sHR, 0.80; 95% CI, 0.70-0.91; P < 0.0011)11.
Summary
Low bone mineral density is an important risk factor for recurrent OVCFs after osteoporotic vertebral fracture surgery, and disulfiramab may enhance bone mineral density and have a significant effect on patients after PVP surgery, especially in elderly patients and in women, preventing recurrent OVCFs and reducing the risk of reoperation.
Expert Profile
Prof. Shuanglin Wan
Professor Wan Shuanglin is a chief physician, medical doctor, master’s degree supervisor, member of the Jiu San Society, deputy director of the Osteoporosis Treatment Center of Run Run Shaw Hospital, Zhejiang University School of Medicine, deputy head of the bone disease group of the Orthopaedic Branch of Zhejiang Medical Association, member of the Osteoporosis and Bone Mineral Diseases Committee of Zhejiang Province, standing committee of the Osteoporosis Committee of the Society of Integrative Medicine of Zhejiang Province, deputy director of the Bone and Soft Tissue Tumor Committee of Zhejiang Anti-Cancer Association, and member of the Rehabilitation Medicine Committee of Zhejiang Province. He is also a member of the Standing Committee of the Osteoporosis Committee of the Zhejiang Association of Integrative Medicine, a member of the Bone and Soft Tissue Tumor Committee of the Zhejiang Anti-Cancer Association, a member of the ICF Committee of the Zhejiang Rehabilitation Medical Association, and a member of the Expert Steering Committee of the Zhejiang Red Cross Society for Emergency Rescue Training. He specializes in the diagnosis and treatment of spine and osteoporosis, especially in the clinical and basic research of osteoporosis, and has completed a number of provincial and ministerial level projects related to this. He has presided over or participated in the key projects of Zhejiang Provincial Natural Science Foundation and National Natural Science Foundation of China. In recent years, his papers on osteoporosis have been published as corresponding author in Journal of Bone and Mineral Research (IF 6.31), Journal of Cellular Biochemistry (IF 3.45), Osteoporosis International (IF 3.86), Cell Commun Signal (IF 5.32) and other journals.
Prof. Lei Ning
D., Deputy Chief Physician, Young Member of Osteoporosis and Bone Mineral Diseases Branch of Zhejiang Medical Association. He specializes in the diagnosis and treatment of cervical spondylosis, Low back pain, and spinal fracture, and has unique attainment in the diagnosis and treatment of osteoporosis, and has published many articles related to osteoporosis in domestic and international journals.
Professor Fan Shunwu
D., Chief Physician, Professor, Doctoral Supervisor, Distinguished Professor of Zhejiang University, Director of the Department of Orthopaedic Surgery, Director of the Lower Back Pain Clinic, Run Run Run Shaw Hospital, Zhejiang University School of Medicine, Former Director of the Orthopaedic Branch of Zhejiang Medical Association, Deputy Director of the Orthopaedic Institute of Zhejiang University, Member of the Orthopaedic Branch of the Chinese Medical Association, Deputy Director of the Lumbar Spine Branch of the Chinese Medical Association, Deputy Director of the International Society of Lumbar Lateral Approach Surgery He is also a member of the Chinese Orthopaedic Association, the Chinese Medical Association, the Lumbar Spine Branch, the International Lumbar Lateral Approach Surgery Society, and the Chinese Orthopaedic Journal, the Chinese Journal of Joint Surgery, and the Chinese Journal of Geriatric Orthopaedics. He is the recipient of the first “Good Doctor of Zhejiang University” of Zhejiang University, the 8th Chinese Physician Award and the 5th Zhejiang Excellent Physician Award, and the cultivation of high-level innovative talents for health in Zhejiang Province.
References
- Wan Shuanglin, Ning Lei, Han Shiliang et al, A retrospective study of recurrent vertebral osteoporotic fractures after percutaneous vertebroplasty, 2014 – The 10th Southern China Osteoporosis Forum and Annual Meeting of Chongqing Medical Association Osteoporosis
2.Johnell O, Kains J A. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures.Osteoporosis International, 2006;17(12):1726-1733.
- Zhong YM, Fu BH, Zhang JL, et al. Clinical study of re-fracture factors after percutaneous transluminal vertebroplasty for osteoporotic spinal compression fractures. Chinese Journal of Orthopaedic Surgery, 2013;21(18):1829-1832.
- Fan Shunwu, Wan Shuanglin, Ma Yan, Issues related to re-fracture and new vertebral fracture after vertebroplasty for osteoporotic fractures, Chinese Journal of Orthopaedic Surgery, 2014;34(01):86-91
- Equuschus Peiwu, The value of BMD in assessing the risk of postoperative re-fracture in patients with osteoporotic fracture PVP. Journal of Hunan Normal University (Medical Edition), 2016;13(6):70-72.
- jin YZ, Lee JH, Xu B et al. Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non- vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. BMC Musculoskeletal Disord,20(1):399.
- Chinese Medical Association, Division of Osteoporosis and Bone Mineral Diseases. Guidelines for the diagnosis and treatment of primary osteoporosis (2017). Chinese Journal of Osteoporosis 1006-7108(2019) 03-0281-29.
8.Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature. 2003; 423(6937):337-42.
9.Cummings SR, Martin JS, McClung MR et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis.N Engl J Med. 2009;361(8):756-65.
10.Bone HG, Wagman RB, Brandi ML et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension.Lancet Diabetes Endocrinol. 2017;5(7):513-523.
11.Kao FC, Hsu YC, Chen TS et al. Effects of Injected Antiosteoporotic Medication Versus Oral Bisphosphonates on Rates of Repeated Vertebroplasty or Kyphoplasty. Clin Ther. 2020; 42(6), 1087-1098.
Author.
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