Malnutrition and Spinal Sagittal Malalignment Are Risk Factors for Incidence of New Vertebral Fractures in Patients with Osteoporosis

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Introduction: Low bone mineral density (BMD), a history of vertebral fractures (VFs), and steroid use are established risk factors for VFs. Additionally, age, nutritional status, muscle mass, and spinal sagittal alignment have been linked to osteoporosis and fractures. This study aims to investigate the risk factors contributing to new occurrences of VFs. Methods: We included 597 patients with osteoporosis who visited our outpatient department and were available for follow-up 1 year after the visit. The following data were collected: age at examination, presence of secondary osteoporosis, body mass index, lumbar spine BMD, femoral neck BMD, number of VFs, grip strength, trunk muscle mass, controlling nutritional status (CONUT) score, sagittal vertical axis (SVA), pelvic tilt, pelvic incidence-lumbar lordosis, thoracic kyphosis on whole-spine standing radiography, and osteoporosis treatment status at baseline. Patients who had new VFs confirmed on whole-spine standing radiography at the 1-year follow-up visit were included in the group with new VF occurrence. We performed between-group comparisons of each parameter. Additionally, to identify risk factors for new VFs, we conducted a multivariate analysis using the presence of new VFs as the dependent variable. Results: A total of 60 new VFs occurred during the 1-year period, representing 10.1% of the study population. When comparing the new VF incidence group with the non-incidence group, the CONUT score and SVA were significantly higher in the new VF incidence group. There were no significant differences between the 2 groups for the other variables. Multiple logistic regression analysis indicated that both a high CONUT score and SVA were independent risk factors for the occurrence of new VFs. Conclusions: The 1-year incidence of new VFs was 10.1% among patients with osteoporosis, despite appropriate osteoporosis treatment. These patients also exhibited malnutrition and spinal sagittal malalignment at baseline. Our findings suggest that malnutrition and spinal sagittal malalignment may be independent risk factors for the occurrence of new VFs.

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