| Title: |
Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly |
| Authors: |
Kaesmacher, Johannes; Schweizer, Claudia; Valentinitsch, Alexander; Baum, Thomas; Rienmüller, Anna; Meyer, Bernhard; Kirschke, Jan S; Ryang, Yu-Mi |
| Contributors: |
Deutsche Forschungsgemeinschaft |
| Source: |
Journal of Bone and Mineral Research ; volume 32, issue 7, page 1582-1588 ; ISSN 0884-0431 1523-4681 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2017 |
| Description: |
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 ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1002/jbmr.3120 |
| Availability: |
https://doi.org/10.1002/jbmr.3120; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fjbmr.3120; https://academic.oup.com/jbmr/article-pdf/32/7/1582/56652346/jbmr3120.pdf |
| Rights: |
https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model |
| Accession Number: |
edsbas.BDEFED7B |
| Database: |
BASE |