Association between visceral fat and osteoporotic vertebral compression refractures

The aims of this study were to examine the association between osteoporotic vertebral compression refractures (OVCRFs) and visceral fat and to identify other risk factors for OVCRFs. We included 311 patients with OVCRs who underwent percutaneous kyphoplasties (PKPs) at our hospital between May 2016 and December 2017. The visceral fat area (VFA) at the plane of the third lumbar vertebra was assessed using preoperative computed tomography (CT) scans. The patients were divided into two groups: OVCRFs and non-OVCRFs. The perioperative variables were compared between the two groups. Univariate and multivariate analyses were used to determine independent risk factors for OVCRFs. Correlation analysis was performed to investigate the association between bone mineral density (BMD) and visceral fat. During the 1-y follow-up, 311 patients were included in the analysis. OVCRFs occurred in 69 patients (22.19%). High VFA was present in 163 patients (52.41%), including 52 OVCRFs and 111 non-OVCRF patients. In all the patients, high VFA (P < 0.001), older age (P = 0.022), female sex (P = 0.020), lower body mass index (BMI; P = 0.028), lower albumin levels (P < 0.001), lower hemoglobin levels (P = 0.045), lower BMD (P < 0.001), lower L3 skeletal muscle index (L3 SMI; P < 0.001), lower subcutaneous fat area (SFA; P = 0.003), higher VFA/SFA ratio (V/S ratio; P < 0.001), higher visceral fat area/muscle area (V/M) ratio (P < 0.001), and higher visceral fat index (VFI; P = 0.001) were associated with OVCRFs. Multivariate analysis revealed that patients of female sex (P < 0.001) and high VFA (P < 0.001) were independent risk predictors for OVCRFs. Higher BMD (P = 0.014) was a protective predictor of OVCRFs. Among all the overweight and obese patients (BMI ≥24 kg/m²), high VFA(P = 0.002), female sex (P = 0.044), lower albumin levels (P = 0.003), lower hemoglobin levels (P = 0.010), lower vitamin D levels (P = 0.037), lower BMD (P < 0.001), lower L3 SMI (P = 0.015), higher V/S ratios (P = 0.003), higher V/M ratios (P < 0.001), and higher VFIs (P = 0.005) were associated with OVCRFs. Multivariate analysis revealed that higher VFAs (P = 0.004) remained an independent predictor of OVCRFs in overweight and obese patients. Higher BMD (P = 0.011) was a protective predictor of OVCRFs. In the correlation analysis, a negative correlation was observed between the BMD and both the visceral fat area and V/M ratio. High VFA is a highly independent risk factor for OVCRFs. Other factors affecting OVCRFs include belonging to the female sex and low BMD. In overweight and obese patients, high VFA and low BMD are independent risk factors for OVCRFs.