Dynamic spine hyperflexion is related to vertebral compression fractures in postmenopausal women

Abstract Background: Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of the spine; however, the fractures are usually associated with the curvature of the spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.Methods: In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women with thoracolumbar fractures (study group) and 310 postmenopausal women with lumbar instability or spondylolisthesis (control group). Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests and unpaired t-tests were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb.Results: Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15–3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and > 20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82–4.27) and 4.83 (3.24–7.20), respectively. TLHCobb and QCT values differed between the study and control groups (p < 0.001 for both). There were no significant differences in body mass index (BMI), disk height, or coronal TLCobb between the two groups.Conclusion: There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.