Controlling Nutritional Status (CONUT) score as a key predictor of disability following conservative treatment of osteoporotic vertebral fractures.

UNLABELLED: This study investigated risk factors for disability in elderly patients with osteoporotic vertebral fractures treated conservatively. Of 173 patients, 27.7% remained disabled at 12 months. Higher CONUT scores, lower lumbar indentation value, and hospitalization were associated with disability, suggesting that nutritional and functional assessments may improve long-term outcomes.

PURPOSE: Although conservative treatment is the standard for osteoporotic vertebral fractures (OVFs), some patients develop persistent disability. This study aimed to investigate the clinical course and risk factors for disability in OVFs.

METHODS

This nested case-control study analyzed data from a multicenter prospective cohort of patients with OVFs treated conservatively. Patients aged > 60 years with MRI-confirmed OVFs were included. At 12 months, patients with an Oswestry Disability Index (ODI) > 40% were classified as the disability group and those with an ODI ≤ 40% as the non-disability group. To control for age-related factors, groups were matched 1:1 by age. Clinical, radiological, and nutritional factors, including the Controlling Nutritional Status (CONUT) score, were compared. Multivariate conditional logistic regression analysis identified independent predictors for disability.

RESULTS

Of 190 patients initially enrolled, 17 were excluded, leaving 173 for analysis. Among these, 27.7% had disabilities at 12 months. After age matching, 44 patients per group (total 88) were analyzed. The disability group showed worsening ODI from 3 to 12 months, whereas the non-disability group improved. Compared with the non-disability group, the disability group had lower lumbar indentation value (LIV), higher CONUT scores, and more frequent hospitalizations. Multivariate analysis identified the CONUT score as an independent risk factor for disability (OR = 1.4, 95% CI 1.1-1.9, p = 0.04).

CONCLUSION

Baseline hospitalization, lower LIV, and higher CONUT scores were associated with disability. Malnutrition was an independent risk factor for disability after OVF. Comprehensive interventions, including rehabilitation and nutritional support, together with bracing and osteoporosis treatment, are essential to prevent long-term impairment of activities of daily living.