Survival analysis after vertebral compression fractures in population over 65 years old

Background: Mortality in vertebral compression fractures (VCF) is rarely directly associated with the fracture. Lower mortality has been demonstrated when fractures are treated surgically (vertebral augmentation) versus conservatively. However, the exact mechanism that justifies this increased survival is unknown. This study aims to analyze overall survival in elderly patients who have suffered a non-pathological VCF, its causes, and the relationship with different factors. Methods: All patients over 65 years old diagnosed with acute, non-pathologic thoracic or lumbar VCF, treated consecutively in our center from January 2017 to December 2020, were retrospectively selected for analysis. Those patients with follow-ups under two years or who required arthrodesis due to poor fracture evolution were excluded. Only the first process was considered for patients who presented a second VCF in the first three months. Results: A total of 509 consecutive fractures were registered. Seventeen were excluded, leaving 492 cases for final analysis. The mean age was 78.9 years old. Overall mortality was 36.2%. Survival rate at 1-, 12-, 24-, 48-, and 60-month follow-up was 97.4%, 86.6%, 78.0%, 64.4%, and 59.4%, respectively. The independent factors associated with a higher mortality risk were age, male, oncologic history, non-traumatic mechanism, and co-morbidity during hospitalization. No statistical differences were found when comparing the two survival curves by treatment (vertebral augmentation vs. conservative management) over time. No benefit was observed in those patients with comprehensive outpatient geriatric care. Conclusion: Age, male sex, history of oncological disease, non-traumatic mechanism of the fracture, and any comorbidity during hospitalization were identified as variables independently associated with a higher risk of mortality following a VCF in the elderly. Vertebral augmentation and comprehensive outpatient geriatric care showed no benefit in overall survival.