Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures
<i>Background and Objectives:</i> Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density o...
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| Formato: | Artigo |
| Idioma: | English |
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MDPI AG
2022-05-01
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| Series: | Medicina |
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| Acceso en liña: | https://www.mdpi.com/1648-9144/58/6/748 |
| _version_ | 1827658582069346304 |
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| author | Harald Krenzlin Leon Schmidt Dragan Jankovic Carina Schulze Marc A. Brockmann Florian Ringel Naureen Keric |
| author_facet | Harald Krenzlin Leon Schmidt Dragan Jankovic Carina Schulze Marc A. Brockmann Florian Ringel Naureen Keric |
| author_sort | Harald Krenzlin |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). <i>Materials and Methods:</i> Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMA<sub>HT</sub>). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). <i>Results:</i> A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (<i>p</i> = 0.77) but correlated with BMI (<i>p</i> = 0.005). The zSMA<sub>HT</sub> was significantly lower in patients suffering from an IF (<i>p</i> = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459–13.04, <i>p</i> = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, <i>p</i> = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMA<sub>HT</sub> (<i>p</i> = 0.0057) and BMD (<i>p</i> = 0.0041) were significantly related to IF occurrence. <i>Conclusion:</i> Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis. |
| first_indexed | 2024-03-09T23:06:41Z |
| format | Article |
| id | doaj.art-3115efada6fa4e05b96ada518c65afb8 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T23:06:41Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj.art-3115efada6fa4e05b96ada518c65afb82023-11-23T17:51:54ZengMDPI AGMedicina1010-660X1648-91442022-05-0158674810.3390/medicina58060748Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral FracturesHarald Krenzlin0Leon Schmidt1Dragan Jankovic2Carina Schulze3Marc A. Brockmann4Florian Ringel5Naureen Keric6Department of Neurosurgery, University Medical Center, 55131 Mainz, GermanyDepartment of Neurosurgery, University Medical Center, 55131 Mainz, GermanyDepartment of Neurosurgery, University Medical Center, 55131 Mainz, GermanyDepartment of Neurosurgery, University Medical Center, 55131 Mainz, GermanyDepartment of Neuroradiology, University Medical Center, 55131 Mainz, GermanyDepartment of Neurosurgery, University Medical Center, 55131 Mainz, GermanyDepartment of Neurosurgery, University Medical Center, 55131 Mainz, Germany<i>Background and Objectives:</i> Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). <i>Materials and Methods:</i> Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMA<sub>HT</sub>). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). <i>Results:</i> A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (<i>p</i> = 0.77) but correlated with BMI (<i>p</i> = 0.005). The zSMA<sub>HT</sub> was significantly lower in patients suffering from an IF (<i>p</i> = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459–13.04, <i>p</i> = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, <i>p</i> = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMA<sub>HT</sub> (<i>p</i> = 0.0057) and BMD (<i>p</i> = 0.0041) were significantly related to IF occurrence. <i>Conclusion:</i> Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis.https://www.mdpi.com/1648-9144/58/6/748sarcopeniaosteoporosisspondylodesisvertebral fracturefrailty |
| spellingShingle | Harald Krenzlin Leon Schmidt Dragan Jankovic Carina Schulze Marc A. Brockmann Florian Ringel Naureen Keric Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures Medicina sarcopenia osteoporosis spondylodesis vertebral fracture frailty |
| title | Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures |
| title_full | Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures |
| title_fullStr | Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures |
| title_full_unstemmed | Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures |
| title_short | Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures |
| title_sort | impact of sarcopenia and bone mineral density on implant failure after dorsal instrumentation in patients with osteoporotic vertebral fractures |
| topic | sarcopenia osteoporosis spondylodesis vertebral fracture frailty |
| url | https://www.mdpi.com/1648-9144/58/6/748 |
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