• Tomoyuki Kusukawa, Keishi Maruo, Masakazu Toi, Tetsuto Yamaura, Masaru Hatano, Kazuma Nagao, Hayato Oishi, Yutaka Horinouchi, Fumihiro Arizumi, Kazuya Kishima, Norichika Yoshie, and Toshiya Tachibana.
• Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan.
• Medicina (Kaunas). 2023 Mar 16; 59 (3).

AbstractBackground and Objectives: Conservative treatment is the gold standard for acute osteoporotic vertebral fractures (AOVFs). However, the treatment strategy for multiple AOVFs remains unknown. We conducted a prospective study using magnetic resonance imaging (MRI) to investigate how rapidly subsequent osteoporotic vertebral fractures (OVFs) occur as domino OVFs within 3 months. This study aimed to assess the incidence and impact of domino OVFs on quality of life (QOL) following conservative treatment for initial AOVFs. Materials and Methods: A prospective multicenter cohort study was conducted at eight hospitals. The included patients were those with AOVFs occurring within 3 weeks, aged >60 years, and diagnosed using MRI. All patients were treated conservatively and underwent MRI after 3 months. Subsequent domino OVFs were defined as newly occurring OVFs within 3 months. Patient characteristics, types of conservative treatment, and patient-reported outcomes, including a visual analogue scale (VAS), the Oswestry disability index (ODI), and the Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ), were evaluated and compared between the domino OVF and non-domino OVF groups. Results: A total of 227 patients were analyzed. The mean age was 80.1 ± 7.3 years and 78% were female. Subsequent domino OVFs were observed in 31 (13.6%) patients within 3 months. An increasing number of prevalent OVFs were significantly associated with domino OVFs (p = 0.01). No significant differences in bone mineral density, type of brace, and anti-osteoporosis medications were found between the two groups. The JOABPEQ (excluding social function), ODI, and VAS were significantly improved after 3 months. Patients with domino OVFs at 3 months had poorer JOABPEQ social life function, ODI, and VAS than those with non-domino OVFs. Conclusions: In this study, the incidence of domino OVFs was 13.6% within 3 months. Domino OVFs had a negative impact on QOL at 3 months and were associated with prevalent OVFs.

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