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Research ArticleSPINE

Symptomatic Refractures after Vertebroplasty in Patients with Steroid-Induced Osteoporosis

M.I. Syed, N.A. Patel, S. Jan, A. Shaikh, B. Grunden and K. Morar
American Journal of Neuroradiology October 2006, 27 (9) 1938-1943;
M.I. Syed
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N.A. Patel
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S. Jan
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A. Shaikh
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B. Grunden
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K. Morar
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  • Article
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Example of patient with steroid-induced osteoporosis. Lateral thoracic spine plain-film radiograph. Initial prevertebroplasty film demonstrates T6 compression fracture.

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    Fig 2.

    Follow-up of the same patient. Lateral thoracic spine plain-film radiograph. One-year follow-up film demonstrates that the patient has undergone vertebroplasties of T5 through T8 and presents with a new fracture of T10 at the time of the study.

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    Fig 3.

    Primary and steroid-induced osteoporotic symptomatic refracture rates comparing 1-year follow-up with an extended follow-up

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    Fig 4.

    Graphs demonstrating relative frequencies of prevalent and incident fractures in both the steroid and osteoporosis groups.

Tables

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    Table 1:

    Medical history of the 37 oral steroid-induced osteoporosis patients

    Medical HistoryNo. of Patients
    COPD18
    Rheumatoid arthritis5
    Asthma3
    Polymyalgia rheumatica3
    Giant cell arteritis2
    Mixed connective tissue disease1
    CNS vasculitis1
    Myasthenia gravis1
    Pulmonary fibrosis1
    Other2
    • Note:—COPD indicates chronic obstructive pulmonary disease; CNS, central nervous system.

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    Table 2:

    Odds ratio (OR) by location of incident fracture: steroid-induced compared to primary

    Location of Incident Fracture
    T3–T11T12–L1L2–L5
    OR (95% CI)3.7 (1.56–8.62)3.0 (1.24–.7.06)1.5 (0.52–4.19)
    P value (group variable).0029.0146.4313
    • View popup
    Table 3:

    Mean number of incident fractures per patient by group and location

    LocationGroupMean No. of Incident Fractures per SubjectP-Value
    Any locationSteroid1.108.0025
    Primary0.397
    T3–T11Steroid0.568.0009
    Primary0.149
    T12–L1Steroid0.351.0025
    Primary0.114
    L2–L5Steroid0.189.2081
    Primary0.134
    • Note:—Because all median are equal to O, means have been reported instead.

    • View popup
    Table 4:

    Analysis of refractures within 1 year

    Percentage of Patients Having a Second Treatment Session Within 1 y of Initial ProcedurePercentage of Refractured Patients Having a Third Treatment Session Within 1 y of Initial ProcedureAverage Available Cement Volumes for Patients Refracuring Within 1 y of Initial Procedure (cc)Average Time Between Treatment Sessions for Refracturing Patients Within 1 y of Initial Procedures
    No. of Patients Having Initial ProcedureNo. Refractured (2nd Procedure)% RefracturingNo. Refractured (2nd Procedure)No. Refractured (3rd Procedure)% of Refractured Patients Having 3rd ProcedureΔt Between 1st and 2nd procedure wkΔt Between 2nd and 3rd procedure wk
    Primary osteoporosis3507220.6722331.9%5.18 ± 2.5811.312
    Steroid-induced osteoporosis371437.814642.9%5.97 ± 3.027.9310.8
    Total3878622.2862933.7%
    Relative risk1.841.34†
    P value.0163.3094
    • * Chi-squared analysis.

    • † Fisher exact test.

    • View popup
    Table 5:

    Prevalent vs incident fractures

    Vertebral LevelPrevalent Fractures in Steroid GroupIncident Fractures in Steroid Group (at 1 y)Prevalent Fractures in Primary Osteoporosis GroupIncident Fractures in Primary Osteoporosis Group (at 1 y)
    T20001
    T30040
    T40070
    T52172
    T61174
    T723245
    T824317
    T932239
    T10352913
    T11654411
    T12868317
    L1679819
    L2735617
    L3925412
    L4953010
    L540124
    Sacrum0001
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American Journal of Neuroradiology: 27 (9)
American Journal of Neuroradiology
Vol. 27, Issue 9
October 2006
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Symptomatic Refractures after Vertebroplasty in Patients with Steroid-Induced Osteoporosis
M.I. Syed, N.A. Patel, S. Jan, A. Shaikh, B. Grunden, K. Morar
American Journal of Neuroradiology Oct 2006, 27 (9) 1938-1943;

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Symptomatic Refractures after Vertebroplasty in Patients with Steroid-Induced Osteoporosis
M.I. Syed, N.A. Patel, S. Jan, A. Shaikh, B. Grunden, K. Morar
American Journal of Neuroradiology Oct 2006, 27 (9) 1938-1943;
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