Comparisons of Bone and Muscle Performance in Patients with Single or Multiple Vertebral Fractures

Abstract

Abstract Patients with multiple fractures tend to be at higher risk of further fractures and are generally associated with more complex and serious clinical problems than patients with single fractures. Musculoskeletal health of patients with single or multiple vertebral fractures has not been thoroughly compared. Therefore, we aimed to compare the BMD, bone turnover, muscularity, fatty infiltration of muscle, and prevalence of co-morbidities in patients with single and multiple vertebral fractures. We recruited 100 patients with single fracture (age 66.96 ± 8.24 years) and 100 with multiple fractures (age 69.90 ± 7.80 years); performed dual-energy X-ray absorptiometry of the femoral neck, hip, and lumbar vertebrae; and measured biochemical markers of bone turnover, muscularity, and fatty infiltration. Patients with multiple vertebral fractures had lower hip BMD (p = 0.010) than those with single fractures, but there was no difference in femoral neck and lumbar vertebral BMD nor in muscularity. However, fatty infiltration, an indicator of muscle quality, was significantly higher in participants with multiple fractures (p = 0.006). Diabetes was significantly more common in patients with multiple fractures (p = 0.042). There were no significant differences in markers of bone turnover, and Seperman analyses showed no correlations of CTX-1 or tPINP with the BMD of the hip, femoral neck, or lumbar spine. However, high CTX-1 was associated with high tPINP (r = 0.4805; p < 0.0001), and marked fatty infiltration was associated with low hip, lumbar vertebral, and femoral neck BMD. Cox regression analyses showed that age (OR 1.057; 95% CI 1.016–1.101; p = 0.006) and low hip BMD (OR 0.016; 95% CI, 0.000–0.549; p = 0.022) were associated with a higher risk of multiple fractures. In conclusion, hip BMD may be a more sensitive indicator for reflecting the fracture severity, patients with multiple fractures tend to have worse skeletal and muscular health, including lower hip BMD and more fatty infiltration of muscle, implying that they should be targeted clinically.