Vertebral fractures cascade: potential risk factors

Abstract Vertebral fractures (VFs) are the most common osteoporotic fractures and are a strong risk factor for subsequent VFs, leading to VF cascade (VFC). We conducted a study to identify potential causes of and risk factors for VFC. At the same time, we also studied the factors influencing the time between fractures in patients with osteoporotic VFC. We retrospectively analysed the clinical data of 889 patients diagnosed with osteoporotic vertebral fracture at Beijing Shijitan Hospital affiliated with Capital Medical University from January 1, 2015, to December 31, 2022. The study included 193 patients with VFC. The multifactorial risk analysis showed that the independent risk factors for VFC included a history of diabetes mellitus (hazard ratio, 1.635; p value = 0.016), a history of oral corticosteroid therapy (hazard ratio, 1.798; p value = 0.001), chronic obstruction pulmonary disease (COPD, hazard ratio 1.666, p value = 0.036), thoracolumbar fracture (hazard ratio, 2.664, p value < 0.001), and a body mass index (BMI) ≥ 28 (hazard ratio 1.421; p value = 0.045). Further study showed that glycated haemoglobin was also an important factor affecting the interval between fractures in patients with VFC. Independent risk factors for VFC include a history of diabetes, prior oral corticosteroid therapy, COPD, thoracolumbar fracture, and BMI ≥ 28. The occurrence of fractures in the thoracolumbar segment is the most important risk factor. Additional research has shown that after the first vertebral fracture, the poorer the patient's blood sugar control, the faster the refracture rate.