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Dokumenttyp:
Clinical Trial; Journal Article
Autor(en):
Kaesmacher, Johannes; Schweizer, Claudia; Valentinitsch, Alexander; Baum, Thomas; Rienmüller, Anna; Meyer, Bernhard; Kirschke, Jan S; Ryang, Yu-Mi
Titel:
Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly.
Abstract:
Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged >=60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built. In all groups, cervical bone mineral density (cBMD) was determined using phantom calibration, and degenerative changes were evaluated in a qualitative manner. In all groups, the severity of degenerative changes of the C-spine increased with age (all p < 0.05) and was inversely correlated with cBMD (all p < 0.05). cBMD was the only significant predictor of a TOF in a multivariate logistic regression model (adjusted odds ratio [OR] = 3.066, 95% confidence interval [CI] 1.432-6.563 for cervical osteoporosis). An association between odontoid cysts and TOF reached significance only in Anderson and D'Alonzo (A&D) type II TOFs (aOR = 1.383; 95% CI 1.012-1.890). Patients with OCSFs, compared with patients with TOFs, were younger (median 74 versus 83 years) and had a higher cBMD (median 208 mg/mL versus 172 mg/mL). No differences were observable when comparing cBMD and grades of degenerative changes between OCSFs and their control group (all p >0.1). Decreased cBMD is the major predisposing factor for the occurrence of TOF but not for OCSF in the elderly. The severity of odontoid cysts was found to be a cBMD-independent factor associated with A&D type II TOFs. However, degenerative changes in the odontoid neighboring joints seem to be an epiphenomenon of bone loss and older age but do not independently predispose for TOF. © 2017 American Society for Bone and Mineral Research.
Zeitschriftentitel:
J Bone Miner Res
Jahr:
2017
Band / Volume:
32
Heft / Issue:
7
Seitenangaben Beitrag:
1582-1588
Sprache:
eng
Volltext / DOI:
doi:10.1002/jbmr.3120
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/28256741
Print-ISSN:
0884-0431
TUM Einrichtung:
Fachgebiet Neuroradiologie (Prof. Zimmer); Neurochirurgische Klinik und Poliklinik
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