Introduction:
Orthotic treatment is a common option for osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical efficacy. The aim of this study was to investigate the effectiveness of orthotic treatment for OVF.
Material and Methods:
A total of 194 patients with fresh OVF enrolled in the 2012 and 2020 prospective cohort studies were included. Those with poor prognostic factors on MRI (confined high intensity area in fractured vertebrae on T2-weighted images) were excluded. While all patients in 2012 cohort study were treated with soft brace, most of all patients in 2020 cohort study were treated without brace. The VAS for low back pain was used for clinical outcome, and X-rays parameters (at sitting and supine position) were used for radiographical evaluation to measure the compression rate of vertebral body and motion angular of vertebral wedging angle. Patients were divided into two groups: brace group and non-brace group. The patients matched by propensity score based on age, sex, compression rate of anterior wall at initial examination, and presence of old OVF, and we statistically compared between the matched groups.
Results:
(Matched brace group / matched non-brace group, respectively.) Propensity score matching revealed 61 cases in each group (mean age 76.6 ± 6.6 years / 76.9 ± 5.9 years (p=0.84), 51 women / 53 women (p=0.61)). The VAS for low back pain was 73.7 ± 16.5 mm / 77.5 ± 17.5 mm at the first examination and 24.0 ± 25.6 mm / 27.0 ± 25.3 mm at 6 months, with no significant difference in improvement (p=0.87, mixed effect models). In radiographical evaluation, the compression rate of anterior wall was 82.0 ± 15.6 % / 79.5 ± 16.6 % at the initial examination and 62.8 ± 21.9 % / 62.8 ± 23.1 % at 6 months (p=0.39, mixed effect models), and the compression rate of posterior wall was 95.6 ± 5.8 % / 96.8 ± 10.0 % at the initial examination and 92.8 ± 8.3 % / 92.2 ± 13.5 % at 6 months (p=0.14, mixed effect models). The angular motion of fractured vertebrae was 4.3 ± 2.7° / 3.2 ± 3.1° at the initial examination and 1.2 ± 2.5° / 2.5 ± 2.7° at 6 months (p=0.007, mixed effect models), showing a significant difference in the amount of change. The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month (p=0.028), and the hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.46 (95% confidence interval 0.20-1.09, generalized Wilcoxon test p=0.054, Kaplan-Meier methods).
Conclusion:
Although orthotic treatment for fresh OVF did not show pain relief effects, it contributed to the stabilization of the fractured vertebra and may reduce the imminent fracture risk of secondary vertebral fracture, often seen immediately after fresh OVF.