title: Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion: a prospective multicenter study.
abstract: METHODS
  Prospective multicenter study.
  
  
  OBJECTIVE
  To identify radiographic or magnetic resonance (MR) images of fresh vertebral fractures that can predict a high risk for delayed union or nonunion of osteoporotic vertebral fractures (OVFs).
  
  
  BACKGROUND
  Vertebral body fractures are the most common fractures in osteoporosis patients. Conservative treatments are typically chosen for OVFs, and associated back pain generally subsides within several weeks with residual persistent deformity of the vertebral body. In some patients, OVF healing is impaired and correlated with prolonged back pain. However, assessments such as plain radiograph or MR images taken during the early phase to predict high risks for nonunions of OVFs and/or poor prognoses have not been identified.
  
  
  METHODS
  A total of 350 OVF patients from 25 institutes were enrolled in this clinical study. Plain radiograph and MR images of the OVFs were routinely taken at enrollment at the respective institutes. The findings on the plain radiograph and MR images were classified after enrollment in the study. All the patients were treated conservatively without any surgical intervention. After a 6-month follow-up, the patients were classified into two groups, a union group and a nonunion group, depending on the presence of an intravertebral cleft on plain radiograph or MR images. The associations of the images from the first visit with those of the corresponding nonunions at the 6-month follow-up were analyzed by multivariate logistic regression to elucidate specific image characteristics that may predict a high risk for nonunion of OVFs.
  
  
  RESULTS
  Forty-eight patients (49 vertebrae) among the 350 patients (363 vertebrae) were classified as nonunions, indicating a nonunion incidence of 13.5% for conventional conservative treatments for OVFs. The statistical analyses revealed that a vertebral fracture in the thoracolumbar spine, presence of a middle-column injury, and a confined high intensity or a diffuse low intensity area in the fractured vertebrae on T2-weighted MR images were significant risk factors for nonunion of OVFs.
  
  
  CONCLUSIONS
  The results of this study revealed significant relationships between plain radiograph and MR images of acute phase OVFs and the incidence of nonunion. As these risk factors are defined more clearly and further validated, they may become essential assessment tools for determining subsequent OVF treatments. Patients with one or more of the earlier-described risk factors for nonunion should be observed carefully and provided with more intensive treatments.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Tsujio
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hidetomi
authors.initials: H
authors.lastname: Terai
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hoshino
authors.forename: Takashi
authors.initials: T
authors.lastname: Namikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
authors.forename: Minori
authors.initials: M
authors.lastname: Kato
authors.forename: Akinobu
authors.initials: A
authors.lastname: Suzuki
authors.forename: Kazushi
authors.initials: K
authors.lastname: Takayama
authors.forename: Wakaba
authors.initials: W
authors.lastname: Fukushima
authors.forename: Kyoko
authors.initials: K
authors.lastname: Kondo
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hirota
authors.forename: Kunio
authors.initials: K
authors.lastname: Takaoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000150:complications*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy