Association of bone metabolic markers, bone mineral density and clinical characteristics with the occurrence of secondary fractures after PVP/PKP for osteoporotic thoracolumbar fractures: a study on logistic
Age, number of operated vertebrae, cement leakage, PINP, 25(OH)D, and BMD are closely associated with and are independent risk factors for secondary fractures after PVP/PKP in OTF patients, and the nomogram model based on these factors has high value.
Abstract
Objective To investigate the relationship between bone metabolism markers, bone mineral density (BMD), clinical characteristics, and the occurrence of secondary fractures after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic thoracolumbar fractures (OTF). Methods A retrospective study was conducted on 107 OTF patients treated in our hospital from May 2023 to May 2024. Patients were divided into secondary fracture and non-fracture groups. Standard univariate analysis, Pearson correlation, collinearity diagnostics, and multivariate logistic regression were performed to identify independent risk factors. A predictive nomogram was constructed and internally validated via bootstrap resampling. Results Significant differences were observed between the fracture and non-fracture groups regarding age, number of operated vertebrae, incidence of cement leakage, levels of type I collagen amino-terminal propeptide (PINP), levels of 25-hydroxyvitamin D (25(OH)D), and BMD (all P < 0.05). Pearson correlation analysis confirmed that all these indicators were strongly correlated with secondary fracture occurrence. Multivariate logistic regression confirmed all six variables as independent risk factors. The nomogram constructed from these factors demonstrated excellent discriminative performance, with an area under the curve (AUC) value of 0.975. The calibration curve indicated no significant difference between predicted and actual probabilities, demonstrating high predictive value. Conclusion Age, number of operated vertebrae, cement leakage, PINP, 25(OH)D, and BMD are closely associated with and are independent risk factors for secondary fractures after PVP/PKP in OTF patients. The nomogram model based on these factors has high value. Screening high-risk populations using these indicators provides crucial theoretical guidance for the clinical prevention and treatment of secondary fractures.
ObjectiveThis study aimed to investigate the associations of multi-dimensional lipid metabolism indicators, comprising serum lipid profiles and the degree of fatty infiltration in the musculoskeletal system, with bone mineral density (BMD) and bone turnover markers (BTMs), and to identify independent risk factors for the occurrence and severity of osteoporotic vertebral compression fractures (OVCFs) in postmenopausal women.MethodsThis retrospective study included a total of 133 postmenopausal women from January 2023 to July 2024. Participants were stratified by fracture status and vertebral compression severity. Clinical data, including bone and lipid metabolic indicators and BMD, were retrieved from electronic medical records and MRI reanalysis. Pearson correlation analyzed associations between lipid metabolic indicators and BTMs/BMD. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for OVCFs, with multicollinearity among variables assessed using the variance inflation factor (VIF), and ordinal logistic regression was applied to assess lipid metabolic indicators' impact on vertebral compression severity. Statistical analyses included Student's t-test or Mann-Whitney U test for group comparisons and one-way analysis of variance (ANOVA) for multiple-group comparisons.ResultThis study included 133 participants: 34 controls, 32 with mild, 38 with moderate, and 29 with severe fractures. Age, BMI, BMD, vertebral bone quality (VBQ), the fatty infiltration ratio of the paraspinal muscles (FIR), and lipoprotein(a) [Lp(a)] differed significantly between fracture and control groups (all p < 0.05). VBQ and FIR were negatively correlated with total BMD (r = -0.466, p < 0.05; r = -0.455, p < 0.05) and positively correlated with the ratio of the fractured vertebra compressed sagittal cross-sectional area (RCSA) (r = 0.344, p < 0.05; r = 0.320, p < 0.05) and age (r = 0.615, p < 0.05; r = 0.283, p < 0.05). Univariate and multivariate regression analyses indicated that VBQ (p = 0.043; OR = 4.260, 95% CI: 1.046-17.345), FIR (p = 0.047; OR = 2.372, 95% CI: 1.010-5.572), and Lp(a) (p = 0.048; OR = 1.002, 95% CI: 1.002-1.799) were independently associated with an increased risk of OVCFs. Ordinal logistic regression confirmed VBQ (p = 0.006; OR = 3.168, 95% CI: 1.378-7.282) and FIR (p = 0.034; OR = 1.156, 95% CI: 1.009-1.325) were associated with increased fracture severity.ConclusionVBQ and FIR were independently associated with osteoporotic fractures in postmenopausal women and were further linked to fracture severity, suggesting their potential value in risk stratification and fracture severity assessment. Although Lp(a) showed a statistically significant association with OVCFs, the association was relatively weak, and its clinical significance requires further validation.
Yihua Zhu, Qian Cheng, Qitai Wu et al.· Journal of Back and Musculos...· 0 citations
Objective: This study aimed to evaluate the relationship between vertebral fracture and various biological factors in patients with type 1 diabetes mellitus (T1DM).
Methods: The study included 61 patients diagnosed with T1DM who were evaluated in the Diabetes Outpatient Clinic between 2017 and 2019, and 49 healthy individuals forming the control group. Demographic and clinical characteristics (age, gender, hypertension, hyperlipidemia, obesity), biochemical parameters (fasting blood glucose, HbA1c, calcium, phosphate, parathyroid hormone, 25-OH vitamin D, C-terminal telopeptide, osteocalcin, alkaline phosphatase), and bone-related variables (L1–L4 and femoral neck bone mineral density [BMD], vertebral fracture status) were comprehensively collected during outpatient visits. Vertebral fractures were assessed by the Genant semi-quantitative method using lateral vertebral fracture assessment images obtained by dual-energy X-ray absorptiometry. Data were analyzed using non-parametric statistical tests and expressed as median (interquartile range). Logistic regression analysis adjusted for age, sex, body mass index (BMI), and phosphate levels was performed.
Results: Vertebral fracture prevalence was significantly higher in T1DM patients (67.2%) compared with controls (26.5%, P < .001). Patients had significantly lower body weight and BMI and higher rates of hyperlipidemia. Femoral neck BMD was significantly lower in the T1DM group (0.967 vs. 1.193 g/cm2, P < .001). Among diabetic patients, those with vertebral fractures had significantly lower serum phosphate levels than those without fractures (3.20 vs. 3.85 mg/dL, P = .008). No significant differences were observed in bone turnover markers or BMD values between patients with and without fractures.
Conclusion: Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls. Lower phosphate levels were observed in patients with fractures, suggesting a potential role of phosphate metabolism in diabetic bone fragility.
Cite this article as: Günhan HG, .etin O, İmre E, Gogas Yavuz D. Bone mineral density and vertebral fracture frequency in a group of type 1 diabetic patients. Cerrahpaşa Med J. 2026, 50, 0091, doi: 10.5152/cjm.2026.25091.
Hatice Gizem Günhan, Okan Çetin, Eren İmredrg et al.· Cerrahpasa Medical Journal· 0 citations
Objective To explore the multiple risk factors for intercostal neuralgia after osteoporotic thoracic vertebral compression fractures (OVCF), and to construct a clinical prediction model. Methods The clinical data of 280 patients with single-segment thoracic OVCF admitted to our orthopedic department from January 2022 to December 2025 were retrospectively collected. Patients were categorized into neuropathic pain (NP) and non-neuropathic pain (non-NP) groups based on the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, with a score of ≥12 defining the primary outcome of intercostal neuralgia as neuropathic pain. Demographic data, fracture-related parameters, bone density, bone metabolism markers, and psychological status (Hospital Anxiety and Depression Scale, HADS) were collected. Univariate and multivariate Logistic regression analyses were used to screen independent risk factors, and the discrimination of the prediction model (area under the ROC curve, AUC) was evaluated. The model’s performance was internally validated using the Bootstrap method. Results Among the 280 patients, the incidence of neuropathic pain was 21.8% (61/280). Multivariate analysis identified six independent risk factors: middle thoracic fracture (T5-T8, OR=4.603), thoracolumbar fascia injury (TLFI, OR=4.883), injured vertebral width ratio (per 0.1 increase, OR=3.973), decreased bone mineral density T-score (per 1-unit decrease, OR=2.685), intravertebral vacuum cleft (IVC, OR=2.764), and depressive state (HADS≥8, OR=2.586). The prediction model showed good calibration (Hosmer-Lemeshow P=0.412) and discrimination (AUC=0.843, 95% CI: 0.789–0.897), with sensitivity 80.3%, specificity 76.7%, and negative predictive value 93.2%. Bootstrap internal validation yielded an optimism-corrected AUC of 0.831. Conclusion Post-fracture intercostal neuralgia in osteoporotic thoracic vertebrae is multifactorial. Middle thoracic vertebra fractures, injury of the thoracolumbar fascia, increased ratio of injured vertebra width, decreased bone density, intravertebral vacuum fissure, and depressive state are independent risk factors. However, external validation in prospective multicenter studies is required before routine clinical implementation.
Dongliang Xiao, Yong-Guang Xu· International Journal of Gen...· 0 citations
Purpose: Sarcopenia causes numerous senior hip fractures. The aim of the study is to investigate the effect of fracture type on hip function, clinical morbidity, and sarcopenia. Postoperative risk variables and prognosis were studied for surgically treated sarcopenic hip fractures.Materials and methods: Skelatal Mass Index (SMI), Total Psoas Area Index (TPAI), and serum dickkopf-related protein-1 (DKK-1) and sclerostin (SOST) were compared. In this single-center study, patients with proximal femur fractures treated at a tertiary trauma hospital between January 1, 2020, and March 1, 2021 were analyzed. Prospective 26-patient sarcopenic pertrochanteric/femoral neck fracture study. Our study included 52 patients (mean age 76.80±9.96 years, 27 males, 25 women). Preoperative lumbar and pelvic CT scans, TPAI, DKK-1, and SOST biochemical markers, postoperative DEXA, and SMI were included. Clinical follow-up assessed walking speed, Harris Hip Score (HHS), and Oxford Hip Score (OHS).Results: SMI was 5.65±0.98 kg/m² in group 1 and 4.88±0.79 in group 2 (p=0.009). The mean TPAI was 488.58±39.87 mm²/m² for group 1 and 455.92±44.3 for group 2 (p=0.007). Total DKK1 mean: 776.4286±577.50 pg/mL. The mean SOST was 1787.80±1262.01 pg/mL. SOST and DKK1 correlate (r=0.27, p=0.054). Group 1 had a mean OHS value of 29.81±4.23 post-op, while Group 2 had 28.85±3.76 (p=0.391). Group 1 had a mean HHS value of 63.27±10.88, while Group 2 had 64.15±7.34. The difference between groups in HHS was not significant (p=0.733). A link exists between OHS and HHS (r=0.79, p<0.001). Gait speed test showed not significant group differences.Conclusion: Femoral neck fracture patients with equal muscle mass may have better functional results, while those with less are at danger. Hip fractures in sarcopenia may elevate DKK1 and SOST.
Emre Atmaca, Özlem Özbaş Demirel, Ercan Dinçel et al.· Pamukkale Medical Journal· 0 citations
The nomogram developed based on conventional clinical data in this study, has undergone internal validation and demonstrated efficacy in predicting NVCF following PVP, and serves as a valuable decision-making tool for clinicians.
Yiqi Wu, Qing Song, Canwei Hu et al.· Frontiers in Medicine· 0 citations
Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland.
M. Warzecha, Edward Czerwiński, J. Amarowicz· Rheumatology· 0 citations
