Recurrence of Vertebral Fracture in Patients With Osteoporotic Vertebral Fractures: Retrospective Review in Moncloa University Hospital. Preliminary Results

Abstract

Background Current drugs for patients who suffer from stablished osteoporosis (OP) with osteoporotic vertebral fracture (VF) have demonstrated their efficacy with different levels of evidence for secondary prevention of fractures1. In fact, this level of efficacy can be limited in real clinical practice, with pluripathological and previously polimedicated patients.

Objectives Main objective of this study is to describe the percentage of patients with VF in which the therapeutic goal of avoiding new VF during their follow-up has been achieved. As a secondary objective, clinical and therapeutic differences will be analyzed among distinct groups arisen from achieving or not the therapeutic goal.

Methods Retrospective, observational, longitudinal, descriptive study of patients from Rheumatology Departament in Moncloa University Hospital who have suffered a osteoporotic VF.

Results 133 cases have been reviewed, 115 (86.5%) females and 18 males (13.5%). Average age is 72 years (+/- 7) and average follow-up time is 2.68 years (+/- 2.3). 25 cases (18.5%) were smokers, 9 (6.8%) oncologic patients, 33 (24%) with chronic corticotherapy and 28 (21%) with immune-mediated diseases. 81 patients (60.9%) had previous VF (0.933 fracture /patient) and 14 (10.5%) non-vertebral fracture (NVF). The average VF was 1.967/patient and 0.133/patient for NVF. 52 patients (39.1%) had received prior treatment for OP (36 Biphosphonate, 23 Denosumab, 5 SERM, 2 strontium ranelate and 1 teriparatide) and in 39 cases (29.3%) a cementoplasty was performed. Initial treatments prescribed by Rheumatology Departament were Biphosphonates (48%),Denosumab (31%) and Teriparatide (21%). 35 patients received sequencial-treatment (26.9%). 86.5 % of patients haven’t presented new VF. 18 cases (13.5%) have been registered with new VF. This group is composed by 13 females and 5 males; the average age was 75 years (+/-7.5) and the average follow-up time 2.8 years (+/- 2.46); 14 (77.8 %) patients presented previous VF and 3 (16.7 %) previous NVF. The average number of previous VF was 2.0/patient and 0.33/patient for NVF. 14 cases (78.8%) of new VF ocurred during the first year of follow-up. The treatment they were receiving at the time of the new VF was in 8 cases with Denosumab (44%), 4 with Teriparatide (22%), 2 Alendronate (11%), 3 Riserdronate (16%) and 1 case without treatment.

Conclusion These are preliminary data from a register for prognosis evaluation of patients who suffer VF in Moncloa University Hospital. A larger sample size is necessary to developed a strategic conclusion in this patients, pluripathological, with previous osteoporotic fractures and treatment.78 % of new VF ocurred during the first year of the follow-up, 44% of them were receiving Denosumab, 77% (vs. 58% of the patients without new VF) had previous VF and 44% (vs. 37% patients without new VF) had received previous OP treatment.