Survival following vertebral compression fractures in population over 65 years old

Abstract

Abstract Background Lower mortality has been demonstrated when vertebral compression fractures (VCFs) are treated surgically (vertebral augmentation) vs. conservatively. Aims To analyze the overall survival in patients over 65 who suffer a VCF, to review the principal causes of death, and to detect which factors are associated with a greater risk of mortality. Methods Patients over 65 years old diagnosed with acute, non-pathologic thoracic or lumbar VCF, treated consecutively from January 2017 to December 2020, were retrospectively selected. Those patients with follow-ups under 2 years or who required arthrodesis were excluded. Overall survival was estimated by the Kaplan–Meier method. Differences in survival were tested through the log-rank test. Multivariable Cox regression was used to assess the association of covariates and time to death. Results A total of 492 cases were included. Overall mortality was 36.2%. Survival rate at 1-, 12-, 24-, 48-, and 60-month follow-up was 97.4%, 86.6%, 78.0%, 64.4%, and 59.4%, respectively. Infection was the leading cause of death. The independent factors associated with a higher mortality risk were age, male, oncologic history, non-traumatic mechanism, and comorbidity during hospitalization. No statistical difference was found when comparing the two survival curves by treatment (vertebral augmentation vs. conservative) over time. Conclusion Overall mortality rate was 36.2% after a median follow-up of 50.5 months (95% CI 48.2; 54.2). Age, male sex, history of oncological disease, non-traumatic mechanism of the fracture, and any comorbidity during hospitalization were identified as variables independently associated with a higher risk of mortality following a VCF in the elderly.