Prediction of Progressive Collapse in Osteoporotic Vertebral Fractures Using Conventional Statistics and Machine Learning

Study design: Retrospective cohort study.Objective: The objective of this study was to determine prognostic factors for the progression of osteoporotic vertebral fracture (OVF) following conservative treatment.Summary of background data: Few studies have evaluated factors associated with progressive collapse (PC) of OVFs. Furthermore, machine learning has not been applied in this context.Materials and methods: The study involved the PC and non-PC groups based on a compression rate of 15%. Clinical data, fracture site, OVF shape, Cobb angle, and anterior wedge angle of the fractured vertebra were evaluated. The presence of intravertebral cleft and the type of bone marrow signal change were analyzed using magnetic resonance imaging. Multivariate logistic regression analysis was performed to identify prognostic factors. In machine learning methods, decision tree and random forest models were used.Results: There were no significant differences in clinical data between the groups. The proportion of fracture shape ( P <0.001) and bone marrow signal change ( P =0.01) were significantly different between the groups. Moderate wedge shape was frequently observed in the non-PC group (31.7%), whereas the normative shape was most common in the PC group (54.7%). The Cobb angle and anterior wedge angle at diagnosis of OVFs were higher in the non-PC group (13.2 +/- 10.9, P =0.001; 14.3 +/- 6.6, P <0.001) than in the PC group (10.3 +/- 11.8, 10.4 +/- 5.5). The bone marrow signal change at the superior aspect of the vertebra was more frequently found in the PC group (42.5%) than in the non-PC group (34.9%). Machine learning revealed that vertebral shape at initial diagnosis was a main predictor of progressive vertebral collapse.Conclusion: The initial shape of the vertebra and bone edema pattern on magnetic resonance imaging appear to be useful prognostic factors for progressive collapse in osteoporotic vertebral fractures.