Vertebral fractures and spinopelvic parameters in patients with osteoporosis

Aim: Bone mineral density (BMD) generally assesses fracture risk in the elderly but is not included in assessment of vertebral fracture status. In this study we aimed to investigate spinal alignment and pelvic orientation in patients with osteoporosis and identify indicators of vertebral fractures (VFs).Methods: Seventy patients above 50 years of age with osteoporosis were included in this retrospective cohort study. Patients were allocated to two groups comprising 29 patients with and 41 patients without VFs. Demographic and clinical characteristics and back pain scores evaluated by Visual Analogue Scale were obtained by scanning patient files. Sagittal vertebral axis (SVA), spinal and pelvic parameters were evaluated with lateral radiography. All parameters and their effect of VFs were compared in both groups. Results: Femoral neck BMD, sacral slope, lumbar lordosis, and pain scores were significantly different in patients with and without VFs (P=0.016, P=0.032, P=0.010, P<0.001, respectively). However, no significant difference was observed in terms of lumbar spine BMD, pelvic tilt, pelvic incidence, and thoracic kyphosis (P=0.394, P=0.313, P=0.258, P=0.341, respectively). Sacral slope and lumbar lordosis were positively correlated in patients with and without VFs (r=0.54, P=0.003 and r=0.50, P=0.001, respectively). SVA>50 mm and pain scores were predictors of VFs according to results of logistic regression. Conclusion: The spinal deformity in patients with osteoporosis may be explained by the spinal parameters. In our study, we concluded that pain and sagittal imbalance in osteoporosis patients are important parameters for vertebral fractures.