Comparative impact of body composition from abdominal computed tomography and paraspinal muscle degeneration on subsequent vertebral fracture risk.

BACKGROUND

Vertebral compression fractures (VCFs) are a growing public health concern, particularly as a complication of osteoporosis, and significantly increase the risk of subsequent VCFs. This study aimed to elucidate the independent contributions of body composition and paraspinal muscle degeneration to subsequent VCFs.

METHODS

This retrospective cohort study enrolled patients diagnosed with acute VCF between 2013 and 2022 who met the following criteria: undergoing abdominal computed tomography (CT) within ±7 days of diagnosis and having a clinical follow-up of ≥1 year. These patients were then categorized into subsequent and non-subsequent VCF groups based on fracture occurrence during follow-up. Body composition parameters at the L3 level and across L1-L5, along with paraspinal muscle indices and FI at L4/5, were assessed using automated CT analysis. Univariate and multivariate logistics were used to identify independent predictors of subsequent VCFs.

RESULTS

A total of 96 patients were included, including 21 in the subsequent VCF group and 75 in the non-subsequent VCF group. Multivariate analysis revealed that higher multi-slice fat infiltration (FI) (odds ratio [OR] = 5.26, 95 % confidence interval [CI]: 1.27-21.77, P = 0.02), lower L4/5 multifidus muscle index (MFMI) (OR = 6.32, 95 % CI: 1.61-24.83, P = 0.01), and a history of non-vertebral fractures (OR = 5.47, 95 % CI: 1.09-27.36, P = 0.04) were independent predictors of subsequent VCFs.

CONCLUSION

This study demonstrates that systemic muscle quality (reflected by muscle FI) and local paraspinal muscle health (specifically MFMI) are independent risk factors for subsequent VCFs, alongside a history of other fractures. These findings underscore the importance of assessing muscle health in the management and prevention of recurrent VCFs.