Computational techniques to segment and classify lumbar compression fractures.

Radiologists interpreting body CT scans may be the first to identify osteoporosis and associated vertebral fractures. This study correlates L1 trabecular attenuation measurements with prevalent vertebral body fractures in older adults undergoing routine CT. Mean L1 trabecular attenuation was measured at thoracoabdominal CT in 1966 consecutive adults (983 men and 983 women) 65 years and older (mean age, 74.1 ± 6.6 [SD] years). Sagittal reconstructions and lateral scouts were analyzed for moderate or severe thoracolumbar vertebral compression fractures according to the Genant semiquantitative assessment method. The diagnostic performance of L1 attenuation for the evaluation of prevalent vertebral fractures was assessed, including ROC curve analysis. A total of 162 (8.2%) individuals (mean age, 78.3 years; 66 men, 96 women) had at least one moderate or severe vertebral fracture. The mean L1 attenuation was 70.2 HU among patients with a prevalent fracture, whereas it was 132.3 HU among patients without fracture (p < 0.001). The prevalence of moderate or severe vertebral compression fractures was 32.5% when L1 attenuation was ≤ 90 HU. Prevalence increased to 49.2% with L1 attenuation of ≤ 50 HU. ROC curve analysis determined an optimal threshold of 90 HU (sensitivity = 86.9%, specificity = 83.9%), with a corresponding AUC of 0.895. The odds ratio of having a moderate or severe vertebral compression fracture was 31.9 for L1 attenuation ≤ 90 HU (95% CI, 20.2-50.5; p < 0.001). Patients with moderate or severe vertebral compression fractures have significantly lower L1 attenuation values than patients who do not. L1 attenuation ≤ 90 HU may represent an optimal threshold for determining risk for osteoporotic vertebral fractures.

Although many vertebral fractures are clinically silent, they are associated with increased risk for subsequent osteoporotic fractures. A substantial number of these fractures are demonstrable using instant vertebral assessment with Hologic densitometers. Whether similar recognition is possible using dual-energy lateral vertebral assessment (LVA) with GE Lunar densitometers remains uncertain. Thus, we evaluated the ability of clinicians using LVA to detect prevalent vertebral fractures. Dual-energy LVA and conventional thoracic and lumbar spine radiographs were concurrently obtained in 80 postmenopausal women. Using an established visual semiquantitative system, vertebral fractures were identified individually by two non-radiologist clinicians on LVA images, and the results were compared with spinal radiograph evaluation by an expert radiologist. Using LVA, 95% of vertebral bodies from T7 through L4 were evaluable, but a majority (66%) of vertebrae from T4 to T6 were not adequately visualized. In the LVA-evaluable vertebrae, prevalent fractures were identified in 40 vertebral bodies by radiography. In this regard, the clinicians using LVA detected 17 of 18 radiographically evident vertebral fractures of grade 2 or 3, a false negative rate of 6%. They identified 50% (11/22) of grade 1 fractures. Additionally, the vast majority of evaluable non-fractured vertebrae, (764/794, 96.2%) were correctly classified as normal by LVA. Thus, clinicians utilizing LVA correctly identified the vast majority of grade 2 or 3 vertebral compression fractures and normal vertebral bodies, although detection of grade 1 fractures was less effective. In conclusion, the low-radiation, dual-energy LVA technique provides a rapid and convenient way for clinicians to identify patients with, and without, grade 2 or 3 vertebral fractures, thereby enhancing care of osteoporotic patients.

Objective To investigate the risk factors of degenerative scoliosis patients with osteoporotic vertebral compression fracture. Methods The data of 150 cases of degenerative scoliosis were retrospectively reviewed from October 2007 to October 2015. According to the occurrence of vertebral compressive fractures, the 150 patients were divided into the experiment group(fracture) and control group(non-fracture). Visual analogue scale(VAS) was used to assess the back pain, and the bone mineral density were measured in patients by using dual-energy X-ray absorptiometry, Cobb angle was measured to evaluate the severity of scoliosis. The occurrence of osteopontin in scoliosis were observed and analyzed. Logistic analysis was used to investigate the risk factors of vertebral compression fractures. Results ①In experiment group, there were T11 vertebral compression fractures in 4 cases, T12 vertebral compression fractures in 13 cases, L1 vertebral compression fractures in 16 cases, and both T12 and L1 vertebral fracture in 5 cases. ②The gender composition of the two groups had no significant difference(χ2=0.253, P=0.615). Compared with the control group, the average age of the experiment group was lower(t=4.392, P<0.01), VAS score was higher(t=14.350, P<0.01), more severe osteoporosis(t=13.296, P<0.01), a higher incidence of osteopontin(χ2=11.824, P=0.001). The Cobb angle of the two groups had no significant difference(t=1.749, P=0.082). After analysis of Logistic regression, trauma history(OR=1.57, 95% CI: 1.09-2.11), bone bridge formation(OR=3.46, 95% CI: 2.10-5.38) and bone osteoporosis(OR=2.48, 95% CI: 1.58-4.36) will increase the chances of patients with fractures. Conclusions Osteoporotic vertebral compression fracture usually occur in thoraco-lumbar region in patients with degenerative scoliosis, and its risk factor are trauma, history, osteoporosis and bone bridge formation. Key words: Osteoporotic fractures; Vertebral compression frature; Degenerative scoliosis; Risk factors

Background: The causes of subsequent vertebral fractures after kyphoplasty are debated. It is reported that most new vertebral fractures after kyphoplasty develop in adjacent vertebrae. Objectives: We explored whether kyphoplasty increases the incidence of adjacent vertebral fractures and identified risk factors for new vertebral compression fractures (VCFs) after kyphoplasty. Study Design: Retrospective study. Setting: Inpatient population of a single center. Methods: We studied 356 patients treated with kyphoplasty from January 2008 to March 2012. Among those patients, there were 35 new VCFs after kyphoplasty. Subsequently, these patients were divided into 2 groups: an “adjacent fracture” group and a “nonadjacent fracture” group. In addition, all patients treated with kyphoplasty were further assigned to either a “new fracture” group or a “no fracture” group. Results: The occurrence of new VCFs in the “nonadjacent fracture” group was significantly higher than that in the “adjacent fracture” group. The average bone mineral density (BMD) of the spine was -3.95 in the “new fracture” group and -2.86 in the “no fracture” group. The risk of new vertebral fracture increased as the bone mineral density decreased (P &lt; 0.05). The morbidity of women was significantly higher in the “new fracture” group (94.29%) than in the “no fracture” group (77.88%) (P = 0.025). Limitations: Retrospective study at a single center. Conclusion: New VCFs after kyphoplasty occurred most often in nonadjacent vertebrae. VCFs after kyphoplasty were common in patients with low bone mineral density and in women, suggesting that osteoporosis is an underlying mechanism. Institutional Review: This study was approved by the institutional review board. Key words: Percutaneous kyphoplasty, vertebral compression fractures, bone mineral density, polymethylmethacrylate, adjacent vertebral fracture

Introduction The incidence of compression spine injuries account for 0.49 % to 0.9 % of total pediatric trauma victims. Spine fractures constitute 7.5 % to 14.6 % of all inpatient hospital admissions and require conservative treatment. The aim of the study is to analyze the system of outpatient rehabilitation of pediatric compression vertebral fractures at follow-up care provided in St. Petersburg. Material and methods Medical records of 1230 children and adolescents who sustained compression fractures of the vertebral bodies and were followed up by orthopaedic surgeons in St. Petersburg between 2011 and 2017 have been reviewed. Results and discussion Pediatric bone fractures constituted 24.8 % of total injuries registered in St. Petersburg in 2017. From pediatric vertebral body victims, 53 % were boys and 47 % were girls. Vertebral fractures were most common in children aged nine, ten and eleven years (range, 13% - 14 %). A system of consistent non-operative treatment performed for the patients at trauma departments of children's hospitals, through inpatient and outpatient services of rehabilitation and restorative treatments, follow-up care in the outpatient setting is presented. Conclusion The incidence of pediatric bone injury and vertebral body compression fractures is higher in St. Petersburg than the average incidence reported in the Russian Federation. Questions of overdiagnosis of vertebral body compression fractures in pediatric population are considered to be important and relevant. An overview of treatment options and strategies, utilization of braces, follow-up term required for children with compression vertebral body fractures suggests revised approaches to treatment methods, length of inpatient management and follow-up care.

Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study

Objective To determine the risk factors for new vertebral fractures following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Methods This retrospective study included 703 patients (133 males and 570 females; 59-88 years, mean 76 years) treated with PVP for OVCF from January 2006 to June 2015. Involved vertebrae included 5 T6,3 T7,19 T8,16 T9,14 T10,46 T11,218 T12,241 L1,137 L2,108 L3,55 L4 and 37 L5. A total of 80 patients were detected with further vertebral fractures (new fracture group) and 623 patients with no new vertebral fractures (control group). Possible risk factors for new vertebral fractures were noted, including age, gender, body mass index (BMI), bone mineral density, involved vertebral segment, amount of cement injection, intradiscal cement leak, and anterior-posterior ratio of the fractured vertebrae. And the fracture group were subdivided into adjacent vertebral fracture group (n=48) and non-adjacent vertebral fracture group (n=32). Results Eighty (11%) of the 703 patients had subsequent vertebral fractures after PVP. Bone mineral density differed significantly between new fracture and control groups [(-3.31±0.74)SD vs. (-2.98±0.86)SD ] (P 0.05). There were no significant differences in all the factors between adjacent vertebral fracture and non-adjacent vertebral fracture groups (P>0.05). Conclusions Severe osteoporosis is the main risk factor of new vertebral fractures after OVCF managed with PVP. Therefore, treatment of osteoporosis is the key point to prevent postoperative new vertebral fractures. Key words: Spinal fractures; Vertebroplasty; Bone density

We examined the relationship between bone mineral density, bone strength, skeletal muscle mass, grip strength, and skin autofluorescence (SAF) in women with osteoporotic vertebral compression fractures (VCF). A total of 1039 women (mean age 73.3 years) were included in our study. These included 222 cases of VCF (mean 77.8 years) and 817 controls (mean 72.0 years). Lumbar and femur BMD were measured for all participants using dual-energy X-ray absorptiometry (DXA). Bone strength surrogates, such as cross-sectional area (CSA) of the proximal femur, were evaluated using Advanced Hip Assessment software. SAF was measured with an autofluorescence reader. We used a bioelectrical impedance analyzer (BIA) to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass (kg)/(height (m))2. We measured bone density, geometric parameters related to bone strength, skeletal muscle mass, grip strength, and SAF in both groups. We also examined factors related to vertebral fracture using multiple logistic regression analysis. Women with vertebral fractures had lower SMI (5.55 vs 5.76 kg/m2, p = 0.0006), smaller femoral cross-sectional area (97.20 vs 100.09, p = 0.014), lower grip strength (16.81 vs 19.16 kg, p < 0.0001), and increased skin autofluorescence (2.38 vs 2.25, p = 0.0002) compared to women without fractures. The prevalence of sarcopenia (SMI < 5.75) was 63.51% in VCF subjects and 52.02% in controls, revealing a high prevalence in VCF (p = 0.002). Skeletal muscle mass and grip strength were not significantly different between patients with acute and old VCF, suggesting that low skeletal muscle mass and muscle weakness may exist before fracture. From the multiple logistic regression analysis, lower femoral density (p = 0.0021), CSA (p = 0.0166), leg muscle mass (p = 0.0127), and left arm grip strength (p = 0.0255) were risk factors for vertebral compression fractures; all were negatively correlated with increased vertebral fractures. Lower limb muscle mass and grip loss may be closely related to the onset of vertebral compression fracture.

Background: Discriminating pathological from osteoporotic vertebral compression ‌a fracture is sometimes challenging.‌Aim: to create scoring system using several MRI signs, trying to correctly ‌differentiate osteoporotic from malignant compression vertebral fractures.‌Patients and method: a prospective case control analytic study was performed in ‌MRI unite of Al-Imamain Al-Kadhemain Medical City/ Baghdad/Iraq, 68 patients (24 ‌male and 44 female) were included, all were presenting with acute back pain and ‌vertebral compression fracture on x ray. MRI was done within 2 months from ‌symptom onset and follow up for at least 4-6 weeks. A 9 MRI signs were evaluated in ‌terms of sensitivity, specificity and accuracy in diagnosis of malignant fractures. A ‌stepwise analysis was used to create a scoring system to differentiate malignant from ‌osteoporotic vertebral compression fractures.‌Results: Malignant vertebral fracture was diagnosed in 13 patients and osteoporotic ‌vertebral fracture 55 patients. All used MRI signs had a variable specificity and ‌sensitivity for diagnosis of malignant fractures but all are statistically significant ‌except one. Mean score for patients with MVF was 3.5 (range of 3-6), while Mean ‌score in patients with OVF was 2.1 (range of 0-4). The optimum score cutoff value ‌was 4 with 61.5% sensitivity, 81.8% specificity, 79.4% accuracy and statistically ‌significant (P-value=0.012) for the discrimination of malignant from osteoporotic ‌vertebral compression fractures.‌Conclusion: Convex posterior vertebral border, asymmetrical diffuse or rounded ‌abnormal bone marrow signal, involvement of the pedicle, and para-vertebral soft ‌tissue mass are highly suggestive MRI sign of malignant fracture. Post contrast ‌enhancement is not a specific sign. Fluid cleft sign is suggestive of osteoporotic ‌fracture. This simple scoring system could be useful tool for the differentiation of ‌malignant and osteoporotic vertebral fractures with the best accurate cutoff value is ‌‌4. ‌Keywords: Magnetic resonance imaging, malignant vertebral compression fracture, ‌Osteoporotic vertebral compression fracture. ‌

Objective To determine the effects of unilateral and bilateral vertebral transpedicular vertebroplasty and kyphoplasty for the treatment of severe osteoporotic vertebral compression fracture. Methods The clinical data of 63 patients with severe osteoporotic vertebral compression fracture, who underwent vertebroplasty or kyphoplasty in our hospital between January 2013 and August 2016, were retrospectively analyzed. The operative time, intraoperative fluoroscopy time, average vertebral bone cement injection volume, bone cement leakage, preoperative and postoperative visual analogue scale (VAS) scores, pain remission rate, and SF-36 health survey questionnaire were recorded. The changes of the vertebral anterior wall, center, and posterior wall vertical height and vertebral kyphosis angle were compared at the baseline, at 3d after the operation, and at the last follow-up. The patients were followed up for 1 year after the operaiton and the time of new vertebral fracture was recorded. Results For the treatment of severe osteoporotic vertebral compression fracture, unilateral transpedicular vertebroplasty was least costly on the operative time and fluoroscopy time. Its bone cement volume per section was less than that of the kyphoplasty, which was the same as the bilateral transpedicular vertebroplasty. The unilateral and bilateral transpedicular vertebroplasty showed more bone cement leakage and the new vertebral fracture time was shorter. The VAS score, physical health comprehensive score and mental health comprehensive score after the operation in the 3 groups were better than those before the operation. Both of the unilateral and bilateral transpedicular vertebroplasty could effectively relieve pain symptoms. The anterior wall, center and posterior wall vertical height significantly increased after the operation compared with those before the operation. The vertebral kyphosis angle in the 3 groups was significantly improved (all P<0.05). Kyphoplasty significantly favored the recovery of anterior wall, center and posterior wall vertical height and improvement of vertebral kyphosis angle. Conclusion For the treatment of severe osteoporotic vertebral compression fracture, vertebroplasty and kyphoplasty may effectively relieve pain symptoms, restore the vertebral body structure and vertebral height. The effect of unilateral and bilateral vertebroplasty is generally the same, with simple operation, short operative time and less cost, whereas the cement leakage rate and the recovery of vertebral height are less than those of kyphoplasty. Key words: Vertebroplasty; Osteoporosis; Compressive fractures

A cadaveric study comparing the biomechanics of unipedicular versus bipedicular kyphoplasty in the treatment of osteoporotic vertebral compression fractures. The objectives of this study were to compare unipedicular kyphoplasty to bipedicular kyphoplasty in restoring strength, stiffness, and height to osteoporotic vertebral compression fractures and to study the degree of unilateral wedging when using a unipedicular versus bipedicular approach to kyphoplasty. Osteoporotic vertebral compression fractures are a common ailment of the elderly that can lead to chronic pain and deformity. Recently developed treatments known as vertebroplasty and kyphoplasty provide pain relief by percutaneously augmenting the fractured vertebral body with polymethyl methacrylate via a transpedicular approach. Vertebroplasty via a unipedicular approach has been shown to provide comparable restoration of vertebral body stiffness when compared to a bipedicular approach. The anticipated benefits of a unipedicular approach include reduction in patient risk, operative time, radiation exposure, and cost. No studies have evaluated the efficacy of unipedicular kyphoplasty. Two fresh-frozen human cadaveric spines (T3-L5) were disarticulated, and the vertebral bodies (n = 30) were compressed using an Instron 8521 machine, recording load versus displacement. The fractured vertebral bodies then underwent kyphoplasty via either a unipedicular or bipedicular approach. The augmented vertebral bodies were then recompressed. The strength, stiffness, and height restoration of the groups were compared. Following recompression, the risk for lateral wedging was evaluated by comparing lateral height measurements. Following fracture and subsequent kyphoplasty augmentation, the mean strength of the bipedicular group was 1.40 kN (+/- 0.38) versus 1.57 kN (+/- 0.55) in the unipedicular group. Average stiffness in the bipedicular group was 0.4387 kN/mm (+/- 0.2095) compared to 0.6880 kN/mm (+/- 0.3179) in the unipedicular group. Postcompression vertebral body height was restored to 96% of prefracture height in the bipedicular group and 94% of prefracture height in the unipedicular group. The mean absolute value of the difference in height between right and left side of the vertebral bodies was 1.06 mm (+/- 1.01) in the bipedicular group, whereas the unipedicular group had a mean of 1.78 mm (+/- 1.84). Statistical analysis using 1-way analysis of variance revealed no significant difference in any of the outcome measurements between the unipedicular and bipedicular groups (P < 0.05). Unipedicular kyphoplasty is comparable to bipedicular kyphoplasty in the restoration of vertebral body strength, stiffness, and height in experimentally induced vertebral compression fractures. There was no greater risk for lateral wedging in the unipedicular group compared to the bipedicular group. Given the advantages of a unipedicular approach with respect to vertebral pedicle cannulation risk, operative time, radiation exposure, and cost, this study would support the use of a unipedicular approach to kyphoplasty in the treatment of vertebral compression fractures.

Differentiation between malignant and benign vertebral compression fractures (VCFs) is important but sometimes difficult, especially in elderly cancer patients. The authors investigated the findings of MR imaging and FDG-PET/CT for the differentiation of VCFs. Between 2007 and 2008, the authors evaluated and treated 102 VCFs in 96 patients. The final diagnosis, based on biopsy results or clinical follow-up, was benign fracture in 67 lesions in 65 patients and malignant fracture in 35 lesions in 31 patients. Magnetic resonance images were obtained in all patients, and FDG-PET/CT was performed in 17 patients in the benign fracture group and 20 in the malignant fracture group. The prevalence of 3 significant MR imaging findings (posterior cortical bulging, epidural mass formation, and pedicle enhancement) and the presence of radiotracer uptake on FDG-PET/CT were evaluated in the 2 groups. The maximum standardized uptake value (SUV(max)) on FDG-PET/CT was compared between the 2 groups, and diagnostic threshold value was sought to confirm malignancy. The diagnostic accuracy of MR imaging and FDG-PET/CT was compared in the differentiation of malignant from benign VCFs. Posterior cortical bulging was seen in 26 (74%) of 35 malignant lesions and 30 (45%) of 67 benign ones, epidural mass formation in 27 (77%) of the malignant lesions and 25% of the benign ones, and pedicle enhancement in 30 (91%) of the 33 malignant lesions and 18 (39%) of the 46 benign ones evaluated with Gd-enhanced MR imaging. These differences were statistically significant for each feature. Sensitivity and specificity for predicting malignancy were, respectively, 74% and 55% for posterior cortical bulging, 77% and 74% for epidural mass formation, and 90% and 61% for pedicle enhancement. Simultaneous occurrence of 3 significant features was found in 21 (64%) of the 33 malignant and 8 (17%) of the 46 benign lesions for which complete MR imaging data were available and showed sensitivity of 64% and specificity of 83%. The presence of radiotracer uptake on FDG-PET/CT was seen in all 20 (100%) of the 20 malignant lesions and 12 (71%) 17 of the benign lesions evaluated by FDG-PET/CT and showed a sensitivity of 100% and specificity of 29%. There was a significant difference in mean (± SD) SUV(max) for the malignant (6.29 ± 3.50) and benign (2.38 ± 1.90) lesions (p < 0.001). The most reliable threshold for SUV(max) was found to be 4.25, which yielded a sensitivity of 85% and a specificity of 71%. When MR imaging findings are equivocal, FDG-PET/CT can be considered as an adjunctive diagnostic method for differentiating malignant from benign VCFs. In comparison with MR imaging, FDG-PET/CT showed slightly higher sensitivity and lower specificity.

Segmental spinal deformity results from vertebral compression fracture (VCF) and progressive collapse of the fractured vertebral body (VB). The VB stenting (VBS) systemⓇ comprises a balloon-assisted, expandable, intrasomatic, metal stent that helps maintain the restored VB during balloon removal and cement injection, which minimizes cement leakage. We performed a prospective, multicenter, clinical trial of the VBS system in Japanese patients with acute VCF owing to primary osteoporosis. Herein, 88 patients, 25 men and 63 women aged 77.4±8.3 years, with low back pain, numerical rating scale (NRS) score of ≥4, and mean VB compression percentage (VBCP) of <60% were enrolled. The primary endpoints were the VBCP restoration rate and reduction in low back pain 1 month and 7 days after VBS surgery, respectively. Secondary endpoints included changes in VBCP, NRS pain score, Beck index, kyphosis angle, and quality of life according to the short form 36 (v2) score. Safety was assessed as adverse events, device malfunctions, and new vertebral fractures. Overall, 70 patients completed the study. VBS surgery increased the restoration rates of anterior and midline VBCP by 31.7%±26.5% (lower 95% confidence intervals (CI): 26.8) and 31.8%±24.6% (lower 95% CI: 27.2), respectively, and the reduction in NRS pain score was -4.5±2.4 (upper 95% CI: -4.0). As these changes were greater than the predetermined primary endpoint values (20% for VBCP and -2 for NRS score), they were judged clinically significant; these changes were maintained throughout the 12-month follow-up (p<0.001). Likewise, significant improvement was observed in the Beck index, kyphosis angle, and quality of life score, which were maintained throughout the follow-up. There were three serious adverse events. New fractures occurred in 12 patients-all in the adjacent VB. VBS surgery effectively restored the collapsed VB, relieved low back pain, and was tolerable in patients with acute osteoporotic VB fracture.

BackgroundOsteoporotic fracture occurs mostly at the spine, in which the commonest one is vertebral compression fracture. Bone turnover markers (BTMs) can be applied to assess bone formation and resorption activity. Nevertheless, there are few reports on BTMs changes after osteoporotic vertebral compression fracture. The aim of this study is to investigate the kinetics of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female.MethodsThree hundred nine postmenopausal female patients with osteoporotic vertebral compression fractures were included in the study. Fasting blood samples were obtained to analyze the serum concentration of bone turnover markers including osteocalcin (OC), β-isomerized type I collagen amino-terminal peptide (β-CTX), alkaline phosphatase (ALP), type I procollagen amino-terminal peptides (PINP), calcium, and phosphorus. According to periods long after vertebral fracture, all the cases were divided into seven phases: phase 1 (within 3 days), phase 2 (3 days to 1 week), phase 3 (1 to 2 weeks), phase 4 (2 to 4 weeks), phase 5 (4 to 12 weeks), phase 6 (12 to 24 weeks), and phase 7 (24 weeks to 1 year). Comparisons among the phases and kinetics during the phases were conducted.ResultsAll the kinds of BTM’s serum concentration began to increase within 3 days after vertebral fracture in phase 1. Osteocalcin and β-CTX had two peaks, the first one in phase 2 (21.4 ± 6.0 ng/ml and 0.72 ± 0.17 ng/ml, respectively) and the second in phase 6 (25.8 ± 7.5 ng/ml and 0.89 ± 0.23 ng/ml, respectively). The peak of ALP arrived in phase 4 at the value of 123.9 ± 25.7 U/L. PINP reached its peak value (69.50 ± 16.82 ng/ml) in phase 6. Serum phosphorus arrived at its first peak (1.21 ± 0.13 mmol/L) in phase 2 and the second peak (1.23 ± 0.13 mmol/L) in phase 4. Serum calcium reached the first peak (2.30 ± 0.07 mmol/L) in phase 3 and the second peak (2.34 ± 0.08 mmol/L) in phase 5.ConclusionThe time-dependent variations of BTMs based on the fracture healing process of inflammation, regeneration, and remodeling occur after vertebral fracture. Kinetics of BTMs after vertebral fracture as well as the reference value at each period were established in the present study. It is helpful to assess vertebral fracture healing process according to the kinetics of BTMs.

Shape, texture and statistical features for classification of benign and malignant vertebral compression fractures in magnetic resonance images