Effect Of Three Anti-osteoporosis Medications To Refractures After PKP Surgery

Purpose: This study compared the three common forms of anti-osteoporosis medication after PKP,including intravenous zoledronic acid,calcium combined with vitamin D and no formal drug treatment,and observed the different effects to the rate of recurrent vertebral fractures postoperatively.Methods: Retrospective analyses was performed in patients from January 2016 to January 2017 who had undergone OVCF and were discharged after a initial PKP surgery at spinal department of Honghui hospital.After the inclusion,exclusion and screening of the target population,the patient's treatments with anti-osteoporosis drugs and the occurrence of vertebral fracture were followed up by telephone interview and hospital review.Through imaging examination combined with medical history and specialist physical examination,the patients were finally classified into the recurrent fracture group and the non-recurrent fracture group.Postoperative drug treatments were divided as zoledronic acid,basic treatment group and non-standard group.General data of all patients including gender,age,preoperative bone mineral density(BMD),final follow-up BMD,height,weight,initial fracture location and the interval time of secondary fracture were collected,and intergroup comparison was conducted.A correlation model was established between preoperative BMD and recurrence interval in refractured group.Chi-square analysis was used to analyze the differences in the incidence of re-fractures among different medications,and pairwise comparison was used for the specific differences.Univariate ANOVA analysis was used to compare the BMD at the final follow-up between the three groups.Results: A total of 363 patients were enrolled,of whom 74 had a total of 79 vertebral bodies with recurrent fractures,and the overall rate of recurrent vertebral fractures was 20.4%.There were no significant differences in gender,age,preoperative BMD and body mass index(BMI)between the two groups(P > 0.05).Among all the patients,43(11.8%)in zoledronic acid group received intravenous zoledronic acid regularly,168(46.3%)received calcium combined with basic vitamin D drugs,and 152(41.9%)received no standard treatment.Preoperative BMD was positively correlated with the interval time of recurrent fracture in the group of recurrent fracture(r=0.376,P < 0.05).After a comparative analysis of the rates among the multiple groups,it was found that the rate of recurrent vertebral fractures in patients receiving intravenous zoledronic acid was significantly lower than that of the other two groups during the follow-up period(P < 0.05),and there was also no statistically significant difference between the basic drug treatment group and the non-standard treatment group(P > 0.05).In terms of BMD at the final follow-up,there were statistically significant differences among the three groups(P < 0.05),and BMD in zoledronic acid group was visibly improved postoperatively.Conclusion: Regular application of zoledronic acid has an obvious prevention effect on recurrent vertebral fracture after PKP surgery;the effect were uncertain for calcium combined with vitamin D or no regularly drug treatment.