Journal Article

Establishment and validation of a nomogram for predicting new fractures after PKP treatment of for osteoporotic vertebral compression fractures in the elderly individuals

Lu, Qi, Chen, Hongliang, Yuan, Feng, Wang, Xuezhi, Ma, Yiming, Wang, Yalei

2023

Overview

Background To investigate the risk factors for new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and to create a nomogram to predict the occurrence of new postoperative fractures. Methods This was a retrospective analysis of the clinical data of 529 OVCF patients who received PKP treatment in our hospital from June 2017 to June 2020. Based on whether there were new fractures within 2 years after surgery, the patients were divided into a new fracture group and a nonnew fracture group. Univariate and multivariate analyses were used to determine the risk factors for the occurrence of NVCFs after surgery. The data were randomly divided into a training set (75%) and a testing set (25%). Nomograms predicting the risk of NVCF occurrence were created based on the results of the multivariate analysis, and performance was evaluated using receiver operating characteristic curves (ROCs), calibration curves, and decision curve analyses (DCAs). A web calculator was created to give clinicians a more convenient interactive experience. Results A total of 56 patients (10.6%) had NVCFs after surgery. The univariate analysis showed significant differences in sex and the incidences of cerebrovascular disease, a positive fracture history, and bone cement intervertebral leakage between the two groups ( P  < 0.05). The multivariate analysis showed that sex [ OR  = 2.621, 95% CI (1.030–6.673), P  = 0.043], cerebrovascular disease [ OR  = 28.522, 95% CI (8.749–92.989), P  = 0.000], fracture history [ OR  = 12.298, 95% CI (6.250–24.199), P  = 0.000], and bone cement intervertebral leakage [ OR  = 2.501, 95% CI (1.029–6.082), P  = 0.043] were independent risk factors that were positively associated with the occurrence of NVCFs. The AUCs of the model were 0.795 ( 95% CI : 0.716–0.874) and 0.861 ( 95% CI : 0.749–0.974) in the training and testing sets, respectively, and the calibration curves showed high agreement between the predicted and actual states. The areas under the decision curve were 0.021 and 0.036, respectively. Conclusion Female sex, cerebrovascular disease, fracture history and bone cement intervertebral leakage are risk factors for NVCF after PKP. Based on this, a highly accurate nomogram was developed, and a webpage calculator ( https://new-fracture.shinyapps.io/DynNomapp/ ) was created.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis / Back pain / Body mass index / Bone density / Bone implants / Cement / Cerebrovascular diseases / Compression / Contrast agents / Development and progression / Epidemiology / Fractures / Health aspects / Internal Medicine / Leakage / Magnetic resonance imaging / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Methods / Multivariate analysis / Musculoskeletal diseases / Nomogram / Nomograms / Nomography (Mathematics) / Older people / Orthopedics / Osteoporosis / Patients / Polymethyl methacrylate / Prediction models / Quality of life / Rehabilitation / Rheumatology / Risk factors / Sex / Spine / Sports Medicine / Surgery / Technologies and innovations to manage spine degeneration / Vertebrae / Vertebral compression fracture / Vertebral kyphoplasty / Vertebroplasty