Sarcopenia in Patients with Osteoporotic Vertebral Fractures is associated with higher risk of Multiple Vertebral Fractures

Abstract Summary Individuals with sarcopenia and osteoporosis often suffer from vertebral fractures. In this study, we show that sarcopenia (reduced muscle mass) is very common in patients with osteoporotic vertebral fractures and triples the risk of suffering from multiple vertebral fractures. Detection of sarcopenia may improve patient care in osteoporosis and prevent future fractures. Background Sarcopenia is widely recognized as a significant risk factor for fractures; however, its role in osteoporotic vertebral fractures (OVFs) remains underexplored. This study aimed to evaluate the prevalence of sarcopenia in patients with OVFs and its relationship with clinical characteristics and outcomes. Methods This retrospective analysis included 142 patients treated for OVFs at a single institution from January 2022 to June 2024. Quantitative assessments of sarcopenia were performed using axial MRI images at the L4 vertebral level. Measurements included the psoas cross-sectional area (pCSA), which was normalized using the psoas muscle index (PMI = pCSA/height 2 ) and the psoas muscle lumbar vertebral body index (PLVI = pCSA/vertebral body area). Fat infiltration (FI) and functional cross-sectional areas (fCSA) were determined using ImageJ®. Sarcopenia was defined using established PMI cutoffs. Clinical parameters, osteoporosis diagnostics (DXA T -scores, CT-based Hounsfield units HU), and patient outcomes were collected. Results Patients had a median age of 81 years (IQR 74–85), and 94 (66.2%) were female. Sarcopenia was identified in 103 patients (72.5%). Patients with sarcopenia had significantly lower BMI, lower serum albumin, and reduced T -scores of the lumbar spine compared to those without sarcopenia. Multiple (≥ 2) vertebral fractures were significantly more frequent in patients with sarcopenia (37.2% vs 18%, p = 0.018). Logistic regression revealed that patients with sarcopenia were 2.78 times more likely to have multiple fractures (95% CI; 1.1–6.9, p = 0.027). Additionally, a significant negative correlation between FI and T -scores of the lumbar spine was observed ( r = −0.242, p = 0.037). By contrast, no significant differences were seen in CT HU values, time to postoperative mobilization, length of hospital stay, or incidence of postoperative wound infections. Conclusions Sarcopenia is highly prevalent among OVF patients and significantly increases the risk of multiple acute fractures. Assessment and management strategies for OVF patients should routinely incorporate evaluation for sarcopenia.