title: Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures.
abstract: METHODS
  Prospective multicenter study.
  
  
  OBJECTIVE
  To examine whether initial conservative treatment interventions for osteoporotic vertebral fractures (OVF) influence patient outcomes.
  
  
  BACKGROUND
  OVFs have been described as stable spinal injuries and, in most cases, are managed well with conservative treatment. However, systematic treatments for OVF have not been clearly established.
  
  
  METHODS
  A total of 362 patients with OVF (59 males and 303 females; mean age, 76.3 yr) from 25 institutes were enrolled in this clinical study. All the patients were treated conservatively without any surgical interventions. The patient outcomes were evaluated 6 months after the fractures on the basis of Short Form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS), activities of daily living (the Japanese long-term care insurance system), back pain (visual analogue scale), cognitive status (mini-mental state examination), and vertebral collapse, which were used as response variables. Furthermore, brace type, hospitalization, bisphosphonates after injury, and painkillers after injury were explanatory variables for the treatment interventions. To evaluate the independent effects of treatment interventions on patient outcomes, we performed multivariate logistic regression analyses and obtained odds ratios that were adjusted for the potential confounding effects of age, sex, level of fracture, presence of middle-column injury, pain visual analogue scale at enrollment, mini-mental state examination score at enrollment, and previous use of steroids.
  
  
  RESULTS
  There was no significant difference for treatment intervention factors including brace type, hospitalization, bisphosphonates after injury, and painkillers after injury. For adjusting factors, the presence of middle-column injury was significantly associated with SF-36 PCS ≤ 40, reduced activities of daily living, prolonged back pain, and vertebral collapse. Female sex and advanced age were associated with SF-36 PCS ≤ 40. Low mini-mental state examination scores at enrollment were associated with SF-36 PCS ≤ 40 and reduced activities of daily living. The previous use of steroids was associated with SF-36 MCS ≤ 40, prolonged back pain, and vertebral collapse. No other examined variables were significant risk factors for patient outcomes.
  
  
  CONCLUSIONS
  These results showed that treatment intervention factors did not affect patient outcomes 6 months after OVF. Middle-column injury was a significant risk factor for both clinical and radiological outcomes. In the future, establishing systematic treatments for cases with middle-column injuries is needed.
  
  
  METHODS
  2.
authors: Spine Center, Shiraniwa Hospital, Nara, Japan. hirotoy@msic.med.osaka-cu.ac.jp
authors: Masatoshi
authors: M
authors: Hoshino
authors: Tadao
authors: T
authors: Tsujio
authors: Hidetomi
authors: H
authors: Terai
authors: Takashi
authors: T
authors: Namikawa
authors: Minori
authors: M
authors: Kato
authors: Akira
authors: A
authors: Matsumura
authors: Akinobu
authors: A
authors: Suzuki
authors: Kazushi
authors: K
authors: Takayama
authors: Kunio
authors: K
authors: Takaoka
authors: Hiroaki
authors: H
authors: Nakamura
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001915:Braces; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D050071:Bone Density Conservation Agents; D004164:Diphosphonates