title: Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study.
abstract: OBJECTIVE
  Postvertebral augmentation vertebral compression fractures are common; repeated vertebral augmentation is usually performed for prompt pain relief. This study aimed to evaluate the incidence and risk factors of repeat vertebral augmentation.
  
  
  METHODS
  We performed a retrospective, nationwide, population-based longitudinal observation study, using the National Health Insurance Research Database (NHIRD) of Taiwan. All patients who received vertebral augmentation for vertebral compression fractures were evaluated. The collected data included patient characteristics (demographics, comorbidities, and medication exposure) and repeat vertebral augmentation. Kaplan-Meier and stratified Cox proportional hazard regressions were performed for analyses.
  
  
  RESULTS
  The overall incidence of repeat vertebral augmentation was 11.3% during the follow-up until 2010. Patients with the following characteristics were at greater risk for repeat vertebral augmentation: female sex (AOR=1.24; 95% confidence interval [CI]: 1.10-2.36), advanced age (AOR=1.60; 95% CI: 1.32-2.08), diabetes mellitus (AOR=4.31; 95% CI: 4.05-5.88), cerebrovascular disease (AOR=4.09; 95% CI: 3.44-5.76), dementia (AOR=1.97; 95% CI: 1.69-2.33), blindness or low vision (AOR=3.72; 95% CI: 2.32-3.95), hypertension (AOR=2.58; 95% CI: 2.35-3.47), and hyperlipidemia (AOR=2.09; 95% CI: 1.67-2.22). Patients taking calcium/vitamin D (AOR=2.98; 95% CI: 1.83-3.93), bisphosphonates (AOR=2.11; 95% CI: 1.26-2.61), or calcitonin (AOR=4.59; 95% CI: 3.40-5.77) were less likely to undergo repeat vertebral augmentation; however, those taking steroids (AOR=7.28; 95% CI: 6.32-8.08), acetaminophen (AOR=3.54; 95% CI: 2.75-4.83), or nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR=6.14; 95% CI: 5.08-7.41) were more likely to undergo repeat vertebral augmentation.
  
  
  CONCLUSIONS
  We conclude that the incidence of repeat vertebral augmentation is rather high. An understanding of risk factors predicting repeat vertebral augmentation provides valuable basis to improve health care for geriatric populations.
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Cheng-Loong
authors.initials: CL
authors.lastname: Liang
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Hao-Kwan
authors.initials: HK
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, China Medical University Hospital, Taichung City, Taiwan.
authors.forename: Fei-Kai
authors.initials: FK
authors.lastname: Syu
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Kang
authors.initials: K
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Po-Chou
authors.initials: PC
authors.lastname: Liliang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D050815:Fractures, Compression / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000601:surgery*; D013624:Taiwan / Q000453:epidemiology; D054854:Vertebroplasty / Q000706:statistics & numerical data*
keywords: bisphosphonate; comorbidity; kyphoplasty; old age; vertebroplasty
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