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Abstract
Background
The relationship between a poor nutritional state and the risk of fractures has not been investigated. This study aimed to investigate the ability of the Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) to predict the incidence of subsequent vertebral fracture (SVF) after percutaneous vertebroplasty (PVP).
Methods
A total of 307 women and 138 men over 50 years old who underwent PVP for osteoporotic vertebral compression fracture (OVCF) were included. Blood biochemical indexes, body mass index (BMI), bone mineral density (BMD), physical function, and muscle strength were measured at baseline. Cox regression analysis was used to determine whether nutritional state was an independent predictor for SVF.
Results
During follow-up, 35 (25.4%) men and 85 (27.7%) women suffered SVF. Patients with SVF had lower BMI, serum albumin levels, GNRI scores, grip strength, lumbar BMD, and Short-Physical Performance Battery (SPPB) scores and higher fall rates and CONUT scores (P < 0.05). Compared with normal nutrition, mild malnutrition was associated with higher risk for SVF (women: HR 2.37, p=0.001, men: HR 2.97, p=0.021 by GNRI; women: HR 2.36, p=0.005, men: HR 3.62, p=0.002 by CONUT) after adjusting for confounding factors. Those with moderate–severe malnutrition also had a higher risk of SVF. Kaplan–Meier analysis showed that poor nutrition state was significantly associated with lower SVF-free survival (P<0.05). The area under curve (AUC) for predicting SVF was 0.65 and 0.73 for the GNRI and 0.67 and 0.66 for the CONUT in men and women, respectively.
Conclusion
GNRI and CONUT are simple and effective tools for predicting SVF in patients undergoing PVP. Health management and nutrition supplement after PVP is a potentially effective prevention strategy against SVF.
Abbreviations
CONUT, Controlling Nutritional Status; GNRI, Geriatric Nutritional Risk Index; SVF, subsequent vertebral fracture; PVP, percutaneous vertebroplasty; OVCF, osteoporotic vertebral compression fracture; BMI, body mass index; BMD, bone mineral density; SPPB, Short-Physical Performance Battery; AUC, area under curve; MRI, magnetic resonance imaging; ROI, region of interest; PSM, paraspinal muscle; CSA, cross-sectional area.
Author Contributions
All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
Xin-Yue Fang and Hao-Wei Xu are co-first authors for this study. Xin-Yue Fang, Hao-Wei Xu, Hao Chen, Shu-Bao Zhang, Yu-Yang Yi, Xiao-Yong Ge and Shan-Jin Wang declare that they have no conflicts of interest in this work.