Aug 2026· Bone· Vol 213, pp.
118054
· 0 citations· 42 references
Medicine
TL;DR
MVFs affected nearly one in six Spanish adults aged ≥40 years, and were independently associated with male sex, older age, and lower hip BMD, and were independently associated with male sex, older age, and lower hip BMD.
Abstract
Most vertebral fractures are asymptomatic and remain underdiagnosed. Vertebral Fracture Assessment (VFA) by Dual-energy X-ray Absorptiometry (DXA) enables low-radiation detection of morphometric vertebral fractures (MVFs). The present study estimated the prevalence of MVFs in Spanish adults aged ≥40 years and characterized affected individuals.
Methods
This multicenter cross-sectional study included 1082 adults (aged 40-80 years) from 15 primary care centers across six Spanish provinces. VFA was performed using a mobile DXA unit (Hologic® Horizon W). Two rheumatologists independently evaluated vertebrae T5-L4 using Genant's method; discrepancies were resolved by consensus. Bone mineral density (BMD) and clinical data were recorded. Primary care physicians reviewed records and imaging to classify MVFs as clinical fragility (CFVFs), traumatic, or morphometric-only.
Results
244 MVFs were identified in 171 participants (15.9%; 95% CI, 13.8-18.2). MVFs were more frequent in men (19.3% vs 12.5%), older individuals, and those with prior non-vertebral fragility fractures, lower hip BMD, or osteoporosis (all p < 0.01). Most were grade 1 (62.7%), anterior (79.9%), and located at the thoracolumbar junction. After review, 52 participants (4.8%) had CFVFs, 19 traumatic fractures, and 100 morphometric fractures. CFVFs were mainly grade 2, anterior, and thoracolumbar. They occurred more often in older women and were associated with previous nonvertebral fragility fractures.
Conclusions
MVFs affected nearly one in six Spanish adults aged ≥40 years, and were independently associated with male sex, older age, and lower hip BMD. CFVFs represented a smaller, underdiagnosed subset and were more frequent in older women, with distinctive severity and localization patterns.
BACKGROUND
Osteoporotic vertebral compression fractures (OVCFs) are prevalent but frequently remain unrecognized. While bone mineral density (BMD) is the primary assessment tool, MRI-based parameters associated with bone and muscle quality may offer additional value, yet sex-specific analyses are limited, despite sex differences in incidence and hormones.
PURPOSE
To explore the associations between MRI-based vertebral bone quality (VBQ) score, psoas muscle index (PMI), and paravertebral muscle fat infiltration (FI) fraction with OVCFs, and to assess the potential diagnostic performance of MRI parameters across sexes.
STUDY TYPE
Retrospective.
POPULATION
260 subjects (≥ 50 years); 130 OVCF patients (73.0 years (67.0-80.0), 89 females) and 130 non-fracture (NF) patients (64.5 years (58.0-73.0), 76 females).
FIELD STRENGTH AND SEQUENCES
3 T and 1.5 T. T1-weighted TSE and T2-weighted TSE (Siemens) and T1-weighted FSE and T2-weighted FSE (United Imaging).
ASSESSMENT
VBQ was calculated on sagittal T1-weighted MRI; PMI and FI were quantified on axial T2-weighted MRI at the L3 endplate by ImageJ. BMD was derived from CT using QCT PRO software. Two trained observers, blinded to clinical data, performed all MRI measurements.
STATISTICAL TESTS
Significance level was set at p < 0.05. t-test/Mann-Whitney U test, chi-squared test (χ2), Spearman's rank correlation coefficient, multivariate logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). Bootstrap resampling (1000 iterations) for internal validation.
RESULTS
The OVCF group exhibited significantly elevated VBQ (3.71 ± 0.55 vs. 3.25 ± 0.58) and FI (24.11% (21.66-28.92) vs. 20.31% (18.90-22.14)), while PMI (3.42 ± 1.02 vs. 4.08 ± 1.14) and BMD (55.82 mg/cm3 (38.75-70.90) vs. 89.24 mg/cm3 (67.80-110.00)) were reduced. FI was independently associated with OVCFs exclusively in females (OR = 1.566). The combined MRI model (VBQ + FI + PMI) yielded a significantly higher AUC in females (AUC = 0.896) than in males (AUC = 0.720).
DATA CONCLUSION
VBQ, PMI, and FI reveal significant sex-specific correlations with OVCFs. The multi-parametric MRI model shows considerable potential as a diagnostic aid for OVCFs in individuals aged over 50, particularly in females.
LEVEL OF EVIDENCE: 4
TECHNICAL EFFICACY STAGE
2 (Diagnostic Accuracy).
Meng Sun, Wanling Jiang, Haoyu Wang et al.· Journal of Magnetic Resonanc...· 1 citation
Objective: This study aimed to determine the epidemiological characteristics of elderly patients hospitalized for spinal fractures at Mousavi Referral Hospital in Zanjan, Iran, from 2021 to 2023. Methods: In this cross-sectional study, medical records of 261 elderly patients hospitalized with vertebral fractures were reviewed. Data on demographic characteristics, injury mechanisms, vertebral involvement, associated injuries, spinal cord damage, and patient outcomes were extracted and analyzed. Results: Of the 261 patients, 138 (52.9%) were men and 123 (47.1%) were women. The mean age was 70.4±8.37 (range: 60-95). Women were significantly older than men (70±11 vs. 67±11, p=0.03). Male patients sustained a significantly higher number of fractured vertebrae than females (p=0.02). The incidence of fractures varied significantly across seasons (p=0.001). The most common fracture site was the thoracolumbar junction (56.2%), and the main cause was falling (58.6%). Spinal cord injuries occurred in 7.3% of patients. The most frequent associated fractures were pelvic (25.9%). The length of hospital stay increased significantly with the presence of associated fractures (p=0.001), spinal cord injuries (p=0.02), and a greater number of fractured vertebrae (p=0.04). Conclusion: Elderly spinal fracture patients, particularly men and those with multiple vertebral fractures, are at an increased risk of spinal cord injury, associated fractures, prolonged hospitalization, and mortality. Falls remain the most frequent cause, and the thoracolumbar junction the most common site. These findings highlighted the need for targeted prevention strategies, cautious clinical management, and early identification of high-risk patients to improve outcomes.
Somayae Abdollahi Sabet, Roya Khodaei· Bulletin of Emergency and Tr...· 0 citations
Osteoporosis screening is essential for early intervention and fracture prevention. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, alternative, cost-effective methods are being explored. Radiogrammetry (DXR) has shown promising results; however, it needs specialized computer software. Hand radiographs, particularly the second metacarpal cortical index (2MCI), have shown promise in BMD evaluation. This study aims to systematically review the evidence on the diagnostic accuracy of the 2nd MCI in assessing BMD. A systematic search of PubMed, Scopus, and EMBASE databases was conducted on May 6, 2025, to identify observational and diagnostic accuracy studies evaluating the relationship between the 2MCI and BMD in adults aged 50 years and older. Case reports and non-English studies were excluded. Data extraction followed PRISMA guidelines, and study quality was assessed using QUADAS-2. Due to heterogeneity in study designs, a narrative synthesis was performed. Six studies with a total of 1028 participants were included. Findings consistently demonstrated that 2MCI radiographs correlate with BMD. In addition, machine learning models enhanced the predictive performance of the 2MCI. However, accuracy of findings particularly sensitivity and specificity remains variable in identifying osteopenia or osteoporosis. This study highlights the importance of adhering to standardized protocols and continuously refining measurement approaches to enhance reliability of 2MCI as screening tool for either osteopenia or osteoporosis. With improved study designs, it further strengthens the clinical applicability of these findings.
Elson Kow, Wiria Aryanta· The Egyptian Journal of Radi...· 0 citations
Background: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity among the elderly population, leading to pain, reduced mobility, and diminished quality of life. Various management strategies exist, including conservative treatment, vertebroplasty, and kyphoplasty; however, optimal treatment remains controversial.
Methods: A prospective observational study was conducted across three tertiary care centres in Odisha, India, from December 2023 to December 2025. A total of 220 patients diagnosed with OVCFs were enrolled. Patients were categorized into three groups: conservative management (Group A), vertebroplasty (Group B), and kyphoplasty (Group C). Outcomes were assessed using Visual analog scale (VAS), Oswestry disability index (ODI), and radiological parameters at baseline, 3 months, 6 months, and 12 months.
Results: Significant improvement in pain and functional outcomes was observed in all groups (p<0.001). Kyphoplasty demonstrated superior pain relief and vertebral height restoration compared to other modalities (p<0.05). Vertebroplasty showed faster early pain relief compared to conservative treatment.
Conclusions: Kyphoplasty offers better long-term outcomes in OVCFs, while vertebroplasty provides rapid pain relief. Conservative treatment remains suitable for mild cases.
Bijay Kumar Lamay, Gopal Krishna Hembram, Amaresh Prasad Mohapatra· International Journal of Res...· 0 citations
Study Design
Retrospective cohort study.
Purpose
To compare short- and medium-term patient-reported outcome measures (PROMs) between thoracic and lumbar percutaneous vertebroplasty (PVP) cohorts for osteoporotic vertebral compression fractures (OVCFs).
Overview of Literature
PVP is well-established for pain relief in OVCF; however, whether clinical outcomes vary by the anatomical location of the treated vertebrae, remains unclear.
Methods
Ninety patients who underwent PVP between January 2010 and August 2022 with complete 2-year PROM follow-up were included and stratified into thoracic (n=33) and lumbar (n=57) cohorts. Outcomes included the Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom score, Visual Analog Scale (VAS) pain score, and Short Form-36 (SF-36) domains. Between-group comparisons were assessed using Wilcoxon rank-sum tests, and effect sizes were summarized using Cliff's delta. Minimal clinically important difference (MCID) achievement was assessed for ODI, VAS Back Pain, and VAS Leg Pain. Multivariable linear regression examined the independent effect of vertebral region after adjustment for age, sex, race, number of vertebral levels treated, and baseline PROMs, with Benjamini-Hochberg false-discovery-rate (FDR) correction applied for multiple comparisons.
Results
The mean age was 76.4±8.5 years, and 83.3% of patients were female. No significant between-group differences were observed in ODI, NASS score, VAS pain score, or any SF-36 domain at 6 months or 2 years (p>0.05). MCID achievement rates for ODI and VAS Back Pain were high and comparable between groups at both follow-up points, exceeding 87%. On adjusted regression, the vertebral region was not an independent predictor of any postoperative PROM after FDR correction.
Conclusions
Thoracic and lumbar vertebroplasty yielded comparable 2-year PROMs with no statistically significant differences detected between cohorts. These findings suggest that the vertebral region may not be a major determinant of patient-reported recovery following vertebroplasty for OVCFs. However, residual confounding, attrition, and absent radiographic variables preclude definitive conclusions regarding clinical equivalence.
Yong Ng, Jeremy Tze En Lim, Lei Jiang et al.· Asian Spine Journal· 0 citations
BACKGROUND
Femoral fractures in children are uncommon and are usually trauma-related; however, some occur secondary to underlying bone pathology. Early differentiation between traumatic and pathological fractures is essential to avoid delayed diagnosis. This study aimed to identify clinical predictors associated with pathological femoral fractures in children.
MATERIAL AND METHODS
In this retrospective single-center comparative study, 432 pediatric patients (0-17 years) with femoral fractures were included. These fractures were classified as traumatic (n = 386, 89.4%; treated between 2011 and 2023) or pathological (n = 46, 10.6%; treated between 2002 and 2021) on the basis of radiological findings, advanced imaging, or histopathological confirmation. Demographic, anatomical, and injury-related variables were compared between the two groups using Mann-Whitney U or chi square tests.
RESULTS
Patients with pathological fractures tended to be older (10.1 ± 4.3 years versus 8.3 ± 5.9 years, p = 0.090) and age-group distribution differed significantly between the two groups (p < 0.001). Traumatic fractures showed a bimodal age distribution, whereas pathological fractures followed a unimodal pattern. Both groups most commonly sustained diaphyseal fractures (58.7% pathological versus 59.8% traumatic). Low-energy trauma mechanisms were significantly more common in pathological fractures (78.9% versus 49.5%, p = 0.001).
CONCLUSIONS
Pathological femoral fractures in children differ from traumatic fractures with respect to age distribution, anatomical location, and injury mechanism. They are more likely to occur following low-energy trauma and demonstrate a different age distribution to traumatic fractures. Careful assessment of patient age, fracture location, and trauma mechanism may aid in the early identification of underlying bone pathology and support appropriate diagnostic evaluation.
Tanja Kraus, Clemens Clar, Jürgen Rünk et al.· Journal of Orthopaedics and...· 0 citations
