200 Section - Sagittal Spinal Alignment as Independent Predictors of Osteoporotic Fractures in Women

Sagittal spinal alignment deteriorates with aging in osteoporotic women and may influence future fracture risk. However, the predictive value of spinal alignment parameters in rehabilitation medicine remains unclear. This study investigated whether sagittal alignment indices independently predict osteoporotic fractures and their potential application in comprehensive fracture prevention strategies.

Design:

This retrospective cohort study enrolled 313 postmenopausal women aged >60 years receiving outpatient osteoporosis treatment from November 2013 to July 2020. After exclusions, 236 participants were analyzed (mean follow-up: 2.9 years). Baseline assessments included bone mineral density (BMD), sagittal alignment parameters (sagittal vertical axis (SVA), pelvic tilt (PT), thoracic kyphosis, pelvic incidence-lumbar lordosis), functional measures (Geriatric Locomotive Function Scale, two-step test, stand-up test), and fall history. Multiple logistic regression analysis identified independent fracture risk factors.

Results:

 Osteoporotic fractures occurred in 33 participants (10.5%), predominantly vertebral fractures (n=20). Multiple logistic regression revealed three independent fracture predictors: fall history (OR=4.092, 95%CI: 1.029-16.265, p=0.045), SVA (standardized OR=4.228, 95%CI: 2.118-8.439, p< 0.001), and PT (standardized OR=2.497, 95%CI: 1.087-5.733, p=0.031). Notably, BMD and functional measures were not independent predictors.

Conclusion:

SVA and PT emerged as powerful independent predictors of osteoporotic fractures, offering significant implications for rehabilitation medicine. Incorporating spinal alignment assessment alongside traditional BMD and functional evaluations enables more precise fracture risk stratification. Early identification of sagittal malalignment provides opportunities for targeted rehabilitation interventions, including postural correction and core strengthening programs. These findings support developing evidence-based rehabilitation protocols targeting spinal alignment parameters to enhance fracture prevention effectiveness in osteoporotic women.