Park JW, et al. - Patients with sacral insufficiency fracture were assessed to determine mortality rates and risk factors associated with mortality. This retrospective cohort study demonstrated that sacral insufficiency fractures were related to increased mortality, like other types of osteoporotic fractures.

Methods

• Patients diagnosed with sacral insufficiency fracture via radiological exam in a single institute from 2001 to 2014, were studied.
• Researchers excluded patients with pathological sacral fracture due to metastasis or primary tumor.
• A review of electronic medical records and mortality data provided by the Korean Statistical Information Service were used to analyze mortality and its predisposing factors.
• Statistical analysis was performed using Kaplan–Meier survival analysis and Cox regression analysis.

Results

• This analysis comprised a total of 325 patients (275 women and 50 men).
• According to data, the mean age at the time of diagnosis was 69.4 years.
• A history of malignancy was reported in 140 patients (43.1%), and 71 patients (21.8%) had undergone pelvic radiation therapy before fracture diagnosis.
• Sacroplasty was performed on 21 patients (6.5%), and the others were managed conservatively after fracture diagnosis.
• Notably, the mean follow-up was 51.5 months, and death of a total of 101 patients was reported at final follow-up.
• Additionally, researchers found that the 6-month mortality rate was 9.8%, the 1-year mortality rate was 17.5%, and the 3-year mortality rate was 25.5%.
• After fractures, an increase was noted in the sex- and age-adjusted standardized mortality ratio (SMR).
• It was noted that the overall SMR was 8.9 at 3 months decreasing to 4.5 at 2 years.
• In multivariable Cox regression analysis, male gender, malignancy history, lumbosacral fusion with distal fusion level S1, stroke history, low total femur bone mineral density score, and low body mass index were identified as significant factors associated with increased mortality.