Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Differences in bone mineral density and muscle mass related to neurological symptoms in osteoporotic lower lumbar vertebral fractures (#130)

Kazuki KF Fujimoto 1 , Haruki DH Ito 1 , Ryosuke RN Nakagawa 1 , Hajime HA Arai 1 , Seiji SO Ohtori 2
  1. Orthopaedic Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa City, Chiba preference, Japan
  2. Orthopaedic Surgery, Graduate School of Medicine Chiba University, Chiba city, Chiba preference, Japan

[Introduction]

Osteoporotic vertebral fractures of the lower lumbar spine occur less frequently than those of the thoracolumbar spine. Patients with lower lumbar fractures have lower bone mineral density (BMD) than those with thoracolumbar fractures. We occasionally encounter patients with lower lumbar fractures concurrent with caudal endplate fractures and neurological symptoms. However, few studies have examined the relationship between caudal endplate fractures and osteoporosis.

 

[Objective]

To investigate the involvement of osteoporosis and sarcopenia in caudal endplate fractures among osteoporotic fractures of the lower lumbar spine.

 

[Methods]

The study included 59 patients (16 men, 43 women, mean age 78.1 ± 11.6 years) who underwent treatment for osteoporotic vertebral fractures of the lower lumbar spine (L3-5) between April 2019 and September 2024 in our institution. The patients were divided into two groups based on the presence or absence of a caudal endplate fracture. The BMD of the lumbar spine and femoral neck, Hounsfield Unit (HU) value of the L2 vertebra, which was not fractured, and cross-sectional area (CSA) of the psoas major muscle at the L3/4 level on magnetic resonance imaging as an indicator of sarcopenia were examined.

 

[Results]

The group without caudal endplate fracture (the "no group") comprised 34 patients (9 men, 25 women, mean age 79.1±8.3 years) and the group with caudal endplate fracture (the "fracture group") comprised 25 patients (7 men, 18 women, mean age 76.9±15.1 years). The HU value of the L2 was 78.4±24.6 HU in the no group and 65.6±34.5 HU in the fracture group, with a significantly lower value in the fracture group (p<0.05). BMD of the lumbar spine tended to be lower in the fracture group (0.83±0.20g/cm2 in the no group and 0.74±0.17g/cm2 in the fracture group), but the difference was not significant (p=0.20). BMD of the femoral neck also tended to be lower in the fracture group (0.55±0.13g/cm2 in the no group and 0.49±0.15g/cm2 in the fracture group), but the difference was not significant (p=0.21). The CSA of the psoas major muscle was 1100.0±375.5 mm2 in the no group and 1197.0±463.0 mm2 in the fracture group, with no significant difference (p=0.9).

 

[Discussion]

In osteoporotic lower lumbar vertebral fractures, patients with caudal endplate fractures, who are likely to present with neurological symptoms, have lower BMD than patients without caudal endplate fractures. The HU value of the non-fractured vertebra is a simple indicator of caudal endplate fracture.