Association between Trunk Muscle Mass and Progression of Vertebral Collapse in Patients Treated Conservatively for Vertebral Compression Fractures

ABSTRACT

Objectives: This study aimed to determine the relationship between trunk muscle mass and progression of vertebral collapse in elderly patients treated conservatively for vertebral compression fractures.

Methods: This retrospective study was conducted in a convalescent ward and included 104 patients (36 men, 68 women; mean age: 83.8 years, minimum age: 65 years) with vertebral compression fractures. Using the semi-quantitative (SQ) method, patients were divided into two groups: the vertebral collapse group (SQ grade increased by at least 1 from admission to discharge) and the vertebral non-collapse group (no change in SQ grade from admission to discharge). The following data were retrieved from medical records: age at admission, sex, fracture site, Charlson Comorbidity Index, Appendicular Skeletal Muscle Mass Index, Trunk Muscle Mass Index (TMI), bone mineral content, Mini Nutritional Assessment—Short Form (MNA-SF), and Sagittal Vertical Axis (SVA) change. Intergroup and logistic regression analyses were performed to evaluate factors associated with the progression of vertebral collapse.

Results: Comparison between the vertebral collapse group and the non-collapse group showed significant difference in TMI (6.2±0.9 kg/m² vs. 5.5±0.6 kg/m², P<0.01), MNA-SF (9.4±1.8 vs. 8±2.1, P<0.01), and SVA change (0.3±0.2 cm vs. 0.7±0.3 cm, P<0.01). Logistic regression analysis showed that TMI was significantly associated with progression to vertebral collapse, regardless of sex [men, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.06–0.73, P<0.05; women, OR: 0.32, 95% CI: 0.12–0.71, P<0.05].

Conclusions: Trunk muscle mass was associated with the progression of vertebral collapse in patients receiving conservative treatment for vertebral compression fractures.

INTRODUCTION

Vertebral compression fracture (VCF) is the most common fracture caused by osteoporosis.¹⁾ Collapse deformity of fractured vertebra has been reported as an adverse event following VCF.²⁾ The occurrence of spinal deformity after VCF involves crushing of the fractured vertebra, followed by kyphosis deformity of the entire spine.³⁾ Spinal kyphosis deformity may secondarily cause decreased balance function and back pain, leading to decreased activities of daily living (ADL) and quality of life (QOL) and increased risk of falls.^4,5,6) In other words, the progression of vertebral body collapse is a factor in spinal kyphosis deformity, and preventing this progression may be important for maintaining spinal alignment and ADL. Magnetic resonance imaging (MRI) studies have reported that the cross-sectional area of the longest lumbar muscle is significantly reduced in patients with VCF compared with patients without VCF, and studies on middle-aged women have reported that the muscle thickness of the erector spinae muscle decreases with increasing thoracic kyphosis.^7,8) Furthermore, studies using computed tomography (CT) have reported that the cross-sectional area of the lumbar multifidus muscle is positively correlated with the angle of lumbar spine lordosis.⁹⁾ These findings suggest that patients with VCF have decreased trunk muscle mass and maintaining trunk muscle mass is important for maintaining spinal alignment. However, although there are scattered reports that identify age,¹⁰⁾ fracture location,¹¹⁾ and comorbidities¹²⁾ as factors associated with vertebral collapse in conservatively treated VCF patients, no study has examined the relationship between trunk muscle mass and the progression of vertebral collapse in these patients. In addition, although CT and MRI have been used to assess trunk muscle mass in previous studies,^13,14) their use on a daily basis may be difficult to justify because of their cost, radiation exposure, and need for trained operators.¹⁵⁾

As an alternative, bioelectrical impedance analysis (BIA) is a noninvasive technique to determine body composition by measuring the electrical resistance of biological tissues and is widely used in clinical practice because of its simplicity and high reliability.^16,17) In addition, it has been reported that trunk muscle mass calculated using BIA is positively correlated with trunk muscle mass determined using MRI and back muscle strength measured using a back muscle dynamometer, indicating high evaluation validity.¹⁸⁾ Therefore, we hypothesized that trunk muscle mass measured using BIA is associated with the progression of vertebral collapse in patients with VCF. In this study, we aimed to clarify this association, which, once confirmed, would validate the use of BIA in the conservative treatment of progressing vertebral body collapse after VCF.

MATERIALS AND METHODS

This was a retrospective observational study. The subjects were patients undergoing conservative therapy for VCF and were admitted to our recovery and rehabilitation unit between 1 April 2022 and 30 June 2024. Patients were included based on the following criteria: thoracolumbar compression fracture, aged 65 years or older, and patients who were weaned after wearing a corset. The following exclusion criteria were used: missing data (13 patients), communication difficulties caused by severe cognitive impairment (7), transfer to other hospitals or death following acute deterioration (5), difficulties with BIA measurement because of pacemaker implantation (3), burst fractures (4), and grade 3 fracture [11 patients with ≥40% decrease in vertebral height based on the semi-quantitative (SQ) method]¹⁹⁾ on admission radiographic findings (Fig. 1).

Fig. 1.

Flowchart of patient selection.

Data Collection

The following data were collected from patient records: admission age, sex, weight, height, body mass index (BMI), Charlson Comorbidity Index (CCI),²⁰⁾ vertebral fracture location, number of vertebral fractures, number of days between VCF injury and admission to our hospital, duration of stay in our hospital, Mini Mental State Examination Japanese (MMSE-J),²¹⁾ grip strength, Mini Nutritional Assessment—Short Form (MNA-SF),²²⁾ body composition (limb skeletal muscle mass, trunk muscle mass, bone mineral content), amount of rehabilitation from admission to discharge (min/day), presence or absence of pharmacotherapy, Functional Independence Measure (FIM)²³⁾ and Sagittal Vertical Axis (SVA)²⁴⁾ at admission and discharge, and SQ grade. The CCI is an index of multimorbidity that scores 19 conditions related to chronic diseases, with higher scores indicating a greater number of comorbidities. The MMSE-J is an 11-item assessment of cognitive functioning, with higher scores indicating better cognitive function. It has a minimum total score of 0 and a maximum of 30. MNA-SF is used as a nutrition screening tool and consists of six items: food intake, weight loss, physical activity, physical and psychological stress, neuropsychological problems, and BMI. Each item is rated on a scale of 0 to 2 (or 3), with a total score of 0 to 14; a score of 7 or lower is considered to indicate poor nutrition. Grip strength was measured twice with the dominant hand using a digital grip strength dynamometer (TKK 5401; Takei Kiki Kogyo, Tokyo, Japan), and the higher value was recorded.²⁵⁾ The FIM is a reliable and validated assessment of ADL consisting of 13 motor items and 5 cognitive items. The level of patient independence is rated on a 7-point scale, with a minimum score of 18 (total dependence) and a maximum score of 126 (fully independent). In this study, FIM gain was calculated by subtracting the FIM at admission from the FIM at discharge. SVA was calculated from whole-spine radiographic findings in the upright position. SVA is the distance between the vertical line from the center of the seventh cervical vertebra to the posterior superior corner angle of the first sacral vertebra; a higher value of SVA indicates greater spinal kyphosis. In this study, to assess spinal kyphosis, the SVA change was calculated by subtracting the admission SVA from the discharge SVA.

Trunk Muscle Mass Index and Appendicular Skeletal Muscle Mass Index

Skeletal muscle mass and bone mineral content were assessed using BIA. Limb skeletal muscle mass was calculated as the sum of the skeletal muscle mass of the four limbs, and trunk muscle mass was calculated by subtracting the skeletal muscle mass of the limbs from the skeletal muscle mass.¹⁵⁾ Appendicular Skeletal Muscle Mass Index (ASMI) and Trunk Muscle Mass Index (TMI) were evaluated as corrected values divided by the square of height for limb skeletal muscle mass and trunk muscle mass, respectively.^26,27) Measurements were taken by a physical therapist using a body composition analyzer (InBody S10; Inbody, Tokyo, Japan) at the time of admission (after 15 min of rest in the supine position, 2 h after a meal).

Presence or Absence of Vertebral Collapse

The SQ method, which evaluates the degree of vertebral compression fracture based on radiographic findings, was used to assess vertebral body collapse. The radiographic examination was performed in the standing position. The vertebral body is classified as normal (grade 0), mild deformity (grade 1: 20%–25% reduction in vertebral height and 10%–20% reduction in vertebral area), moderate deformity (grade 2: 25%–40% reduction in vertebral height and 20%–40% reduction in vertebral area), or severe deformity (grade 3: >40% reduction in vertebral height and area). Grade 1 or higher is considered a vertebral fracture, and the validity and reliability of the SQ method for assessing the degree of osteoporotic vertebral fracture are reportedly high.²⁸⁾ Patients whose SQ grade increased by at least one grade from admission to discharge were classified as having vertebral collapse, and those whose grade did not change were classified as having no vertebral collapse.²⁹⁾ The SQ grade was diagnosed by the attending physician and SQ grade data were retrieved from patient records.

Rehabilitation Methods

All patients received standard rehabilitation in the recovery unit for 90–120 min per day, 5 days per week. The rehabilitation program included joint mobilization exercises, muscle strengthening, ADL exercises, and psychological support. Interventions were performed in bed to prevent disuse until corset application was completed, and the patients were weaned after 1 week of bed rest. Nonsteroidal anti-inflammatory drugs were used for pain management.

Ethics Approval

This study was reviewed and approved by the Ethical Review Committee of the Okayama Saiseikai General Hospital (ID: 240902). Because of the retrospective design of this study, all participants were offered the opportunity to exclude their data from the analysis using an opt-out method. All experimental procedures were performed in accordance with the principles of the Declaration of Helsinki (revised October 2013).

Statistical Analysis

The Shapiro–Wilk test was used to determine normality. Age at admission, BMI, length of hospital stay, CCI, MMSE-J, MNA-SF, grip strength, ASMI, TMI, bone mineral content, SVA, days from VCF onset to admission, FIM at admission and discharge, and rehabilitation time were compared between the groups using either the unpaired t-test or the Mann–Whitney U test. Sex, fracture site, number of fractures, presence or absence of pharmacotherapy, and SQ grade were compared between groups using the χ² test for independence or Fisher’s exact probability test. Quantitative variables are expressed as mean ± standard deviation or median (interquartile range). Logistic regression analysis (forced entry method) was used to evaluate the association between progression of vertebral collapse and trunk muscle mass. As explanatory variables, we selected items associated with vertebral body crush^6,7,8) and those potentially associated with vertebral collapse. The objective variable was the progression of vertebral collapse, and the explanatory variables were age at admission, fracture site, CCI, MNA-SF, grip strength, SMI, TMI, bone mineral content, SVA change, FIM gain, duration of exercise during hospitalization, and hospital stay. In addition, we confirmed the absence of multicollinearity when the variance inflation factor (VIF) between all variables was less than 5. The results of multiple logistic regression analysis were examined using odds ratios (ORs) and 95% confidence intervals (95% CIs), and the goodness-of-fit of the model was examined using the Hosmer–Lemeshow goodness-of-fit test. Model discriminability was measured using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Given that skeletal muscle mass and grip strength are higher in men than in women, in this study, skeletal muscle mass and grip strength were analyzed according to sex.^30,31) All statistical analyses were performed using EZR version 1.68 (Saitama Medical Center, Saitama, Japan).³²⁾ Statistical significance was set at P<0.05.

RESULTS

A total of 147 patients with VCF were included in this study. Of them, 43 were excluded, and the remaining 104 patients (36 men and 68 women) were included in the analysis. The mean age of the patients was 83.8±9 years; the vertebral collapse group had 43 patients (13 men and 30 women) and the vertebral non-collapse group had 61 patients (23 men and 38 women). Demographic and clinical characteristics of the patients are presented in Table 1. In comparing the vertebral collapse group with the non-collapse group, significant differences were observed for MMSE-J (22.6±5.3 vs. 19.2±5.6, P<0.01), MNA-SF (9.4±1.8 vs. 8±2.1, P<0.01), grip strength (male, 23.9±7.2 kg vs. 17±5.8 kg, P<0.01; female, 15.7±4.6 kg vs. 12.6±3.7 kg, P<0.01), TMI (male, 6.7±0.9 kg/m² vs. 6.0±0.4 kg/m², P<0.01; female, 5.8±0.6 kg/m² vs. 5.3±0.7 kg/m², P<0.01), SVA at admission (4.6±1.1 cm vs. 5.1±1 cm, P<0.01), SVA at discharge (5.0±1.2 cm vs. 5.9±1.1 cm, P<0.01), SVA change (0.3±0.2 cm vs. 0.7±0.3 cm, P<0.01), FIM at admission (65.7±22.6 vs. 56.7±18.6, P<0.05), FIM at discharge (99.1±23.8 vs. 80±24.4, P<0.01), and FIM gain (33.4±17.6 vs. 23.2±15.8, P<0.01). Because we observed multicollinearity between fracture type, CCI, and MNA-SF in male participants, these variables were excluded as independent variables. The results of logistic regression analysis related to the progression of vertebral collapse are shown in Tables 2 and 3. In male participants, TMI [OR: 12.1, 95% CI: 1.6–333.6, P=0.04] and SVA change [OR: 0.01, 95% CI: 0.001–0.02, P=0.02] were significantly associated with progression of vertebral collapse. In female participants, age [OR: 1.3, 95% CI: 1.04–1.75, P=0.04], MNA-SF [OR: 2.43, 95% CI: 1.19–6.12, P=0.03], TMI [OR: 38.2, 95% CI: 2.63–210.9, P=0.02], and SVA change [OR: 0.02, 95% CI: 0.001–0.31, P=0.01] were significantly associated with progression of vertebral collapse. AUC was 0.95 (95% CI: 0.89–0.99) for male participants and 0.91 (95% CI: 0.84–0.98) for female participants; assessment of model calibration using the Hosmer–Lemeshow goodness-of-fit test showed P=0.75 and P=0.52, respectively.

Table 1. Characteristics of patients in the collapsed and non-collapsed vertebral body groups

Characteristic	All patients (n=104)	Collapsed group (n=43)	Non-collapsed group (n=61)	P value
Age, years	83.8±9	85.8±5.8	82.4±10.5	0.22
BMI, kg/m2	20.4±3.6	19.8±3.6	20.8±3.6	0.17
Sex, n (%)				0.43
Male	36 (35)	13 (36)	23 (64)
Female	68 (65)	30 (44)	38 (56)
Fracture type, n (%)				0.45
Thoracic vertebral fracture	19 (18)	7 (16)	12 (20)
Lumbar vertebral fracture	60 (58)	23 (54)	37 (60)
Thoracolumbar fracture	25 (24)	13 (30)	12 (20)
Number of fractures	1: 60 2: 44	1: 24 2: 19	1: 36 2: 25	0.74
Vitamin D (P/A)	4/100	3/40	1/60	0.16
Bisphosphonate (P/A)	1/103	1/42	0/61	0.23
Parathyroid hormone (P/A)	2/102	1/42	1/60	0.80
Collapse grade on admission	1: 34, 2: 70, 3: 0	1: 9, 2: 34, 3: 0	1: 25, 2: 36, 3: 0	0.03
Collapse grade at discharge	1: 25, 2: 46, 3: 33	1: 0, 2: 10, 3: 33	1: 25, 2: 36, 3: 0	<0.01
Onset–admission, days	2.3±1.4	2.3±1.5	2.3±1.4	0.74
Length of hospital stay, days	54.6±15.1	53.8±13.9	55.1±15.9	0.77
CCI	1 [1–2]	1 [1–2]	1 [1–2]	0.07
MMSE-J	21.2±5.6	19.2±5.6	22.6±5.3	<0.01
MNA-SF	8 [8–10]	8 [8–9]	9 [8–11]	<0.01
Grip strength, kg	16.8±6.6	14.0±4.8	18.8±6.9	<0.01
Male	21.4±7.4	17.0±5.8	23.9±7.2	<0.01
Female	14.3±4.4	12.6±3.7	15.7±4.6	<0.01
ASMI on admission, kg/m2	5.1±1.1	4.9±1	5.3±1.1	0.13
Male	6.1±0.9	5.8±1	6.2±0.8	0.30
Female	4.6±0.8	4.4±0.6	4.7±0.9	0.56
TMI on admission, kg/m2	5.9±0.8	5.5±0.6	6.2±0.9	<0.01
Male	6.5±0.8	6.0±0.4	6.7±0.9	<0.01
Female	5.6±0.7	5.3±0.7	5.8±0.6	<0.01
Bone mineral, kg	1.9±0.2	1.9±0.1	2.0±0.2	0.04
Male	2.1±0.2	2.0±0.2	2.1±0.1	0.02
Female	1.8±0.1	1.85±0.1	1.89±01	0.2
SVA on admission, cm	4.8±1.1	5.1±1	4.6±1.1	<0.01
SVA at discharge, cm	5.3±1.2	5.9±1.1	5±1.2	<0.01
SVA change, cm	0.5±0.3	0.7±0.3	0.3±0.2	<0.01
FIM on admission	62.0±21.4	56.7±18.6	65.7±22.6	0.04
FIM at discharge	91.2±25.8	80.0±24.4	99.1±23.8	<0.01
FIM gain	29.2±17.5	23.2±15.8	33.4±17.6	<0.01
Rehabilitation, min/day	97.6±6.2	98.1±6.2	97.2±6.2	0.70

Data given as mean±standard deviation, number (percentage), number, or median [interquartile range].

P, present; A, absent

Table 2. Logistic regression analysis of vertebral collapse for male participants (n=36)

Factor	Univariate model			Multivariate model
	Odds ratio (95% CI)	P value		Odds ratio (95% CI)	P value	VIF
Age	1.08 (1–1.1)	0.06		0.91 (0.74–1.08)	0.19	1.83
Fracture type	4.67 (1.19–30.8)	0.05		―	―	―
CCI	2.6 (1.19–6.86)	0.02		―	―	―
Length of hospital stay	0.95 (0.88–1.02)	0.24		0.91 (0.76–1.05)	0.23	2.52
MNA-SF	0.6 (0.33–0.95)	0.05		―	―	―
Grip strength	0.84 (0.72–0.95)	0.01		0.76 (0.44–1.08)	0.2	2.58
ASMI	0.63 (0.27–1.36)	0.25		0.28 (0.02–1.4)	0.21	1.48
TMI	7.69 (2.1–48.8)	<0.01		12.1 (1.6–333.6)	0.04	1.65
Bone mineral	0.02 (0–0.9)	0.06		0.19 (0.001–0.65)	0.58	1.45
SVA change	0.01 (0.001–0.04)	<0.01		0.01 (0.001–0.02)	0.02	2.23
FIM gain	1.03 (1–1.07)	0.03		1.03 (0.93–1.16)	0.05	2.24
Rehabilitation volume	0.99 (0.87–1.11)	0.88		0.87 (0.58–1.14)	0.39	1.39

χ² test P<0.05, Hosmer–Lemeshow test P=0.75, AUC 0.95 (95% CI 0.89–0.99).

Table 3. Logistic regression analysis of vertebral collapse for female participants (n=68)

Factor	Univariate model			Multivariate model
	Odds ratio (95% CI)	P value		Odds ratio (95% CI)	P value	VIF
Age	1.01 (0.92–1.1)	0.78		1.3 (1.04–1.75)	0.04	4.06
Fracture type	1.31 (0.64–2.73)	0.45		0.46 (0.11–1.61)	0.24	1.52
CCI	1.09 (0.55–2.15)	0.79		1.24 (0.36–4.53)	0.73	1.62
Length of hospital stay	0.99 (0.96–1.02)	0.94		0.97 (0.9–1.03)	0.35	2.02
MNA-SF	0.6 (0.4–0.84)	<0.01		2.43 (1.19–6.12)	0.02	2.38
Grip strength	0.84 (0.73–0.95)	<0.01		1.09 (0.87–1.39)	0.44	1.92
ASMI	0.67 (0.34–1.23)	0.22		0.38 (0.07–1.64)	0.2	3.33
TMI	6.03 (2.22–21.3)	<0.01		38.2 (2.63–210.9)	0.02	4.11
Bone mineral	0.2 (0.01–4.08)	0.3		0.49 (0.001–233)	0.82	1.77
SVA change	0.01 (0.001–0.09)	<0.01		0.02 (0.001–0.31)	0.01	1.65
FIM gain	1.03 (1–1.07)	0.05		1.02 (0.95–1.1)	0.51	1.71
Rehabilitation volume	1.03 (0.96–1.11)	0.38		0.86 (0.67–1.05)	0.19	2.79

χ² test P<0.05, Hosmer–Lemeshow test P=0.52, AUC 0.91 (95% CI 0.84–0.98).

DISCUSSION

Previous studies have reported that the thickness of the erector spinae muscle decreases with increasing thoracic kyphosis and that the cross-sectional area of the lumbar multifidus muscle is positively correlated with the angle of anteversion of the lumbar spine.^8,9) These findings suggest that trunk muscle mass is important in maintaining spinal alignment. However, these studies were conducted on middle-aged women and patients with spinal degeneration and not on patients with VCF. Therefore, in this study, we aimed to clarify the relationship between TMI assessed using BIA and the progression of vertebral collapse in patients with VCF on conservative therapy. Our results suggest that TMI is associated with the progression of vertebral collapse and may be an important consideration in preventing vertebral collapse after a VCF injury.

The results of this study indicated that TMI is a superior correlate of the progression of vertebral collapse compared to ASMI in patients with VCF receiving conservative therapy. Previous studies in community-dwelling older individuals and patients with kyphosis deformity reported an association between TMI calculated from BIA and spinal deformity, but not with ASMI.^15,33) These findings are consistent with the results of our study in patients with VCF. The logistic regression analysis of this study also showed that the progression of vertebral collapse was associated with the progression of spinal kyphosis deformity, suggesting the importance of trunk muscle mass in spinal kyphosis deformity.

Age-related skeletal muscle loss tends to occur in the lower limbs, which have more type II fibers, whereas trunk muscles, which have more type I fibers, are less susceptible to age-related atrophy.³⁴⁾ In contrast, patients with VCF have a reduced cross-sectional area of the longest lumbar muscle compared to elderly patients without VCF, and the muscle mass of the lumbar multifidus muscle decreases with bed rest.³⁵⁾ Therefore, reduced trunk muscle mass in patients with VCF may be associated with VCF injury or post-injury rest. In patients with acute VCF, early weaning from bed and prevention of trunk muscle weakness are considered important for improving QOL,³⁵⁾ and the use of electrical muscle stimulation (EMS) for trunk muscle training is recommended during periods of high pain.³⁶⁾ Because trunk muscle mass, as measured by BIA, is related to paraspinal muscle cross-sectional area and back muscle strength, as measured by MRI,¹⁸⁾ patients with reduced trunk muscle mass at the time of admission need interventions focused on the trunk muscles from the early stages of admission. The results of this study suggest that patients should be encouraged to get out of bed as early as possible to prevent vertebral collapse and that trunk muscle EMS can be used during the bed rest period when pain is high.

The findings of this study also suggest that the assessment of trunk muscle mass using BIA may be useful for assessing the progression of vertebral collapse; trunk muscle mass was assessed using BIA in this study, rather than CT or MRI^13,14) as reported in previous studies. However, evaluation of trunk muscle mass using MRI or CT is difficult to justify on a daily basis because of cost, radiation exposure, and the need for a qualified medical imaging technician.¹⁵⁾ In contrast, BIA is a noninvasive and simple test that determines body composition by measuring the electrical resistance of biological tissues and is widely used in clinical practice because of its high reliability.^16,17) Moreover, the evaluation validity of this method is high because the trunk muscle mass calculated using BIA correlates with the trunk muscle mass and back muscle strength calculated using MRI.¹⁸⁾ Therefore, BIA can be performed safely and easily in bed from the early stages after VCF injury to evaluate trunk muscle mass.

The present study has some limitations. First, this study evaluated bone mineral content using BIA, but not evaluate bone mineral density (BMD), which is commonly used to evaluate osteoporosis, and the possibility that reduced BMD may influence vertebral collapse cannot be ruled out.³⁷⁾ Therefore, future validation should also assess osteoporosis, including BMD. Second, the sample size was small because this was a single-center study, which may have introduced selection bias. Therefore, similar validation in other samples may not yield the same results as this study. In addition, the results of this study cannot be generalized to all elderly patients presenting with VCF, because the patients in this study were admitted to a recovery rehabilitation ward and their life backgrounds were different from those of elderly patients living in the community or patients admitted to an institution. Third, because this was a retrospective study, the information that could be collected was limited and the details of the exercise therapy performed were unknown. Fourth, it is difficult to establish a causal relationship from the results of this study, and it cannot be clearly demonstrated that increasing the trunk muscle mass is effective in preventing the progression of spinal collapse. Therefore, prospective and multicenter studies should be conducted in the future to investigate confounding factors and to account for selection bias.

CONCLUSION

Trunk muscle mass measured by BIA is associated with the progression of vertebral collapse in conservatively treated patients with VCF, suggesting that interventions focused on trunk muscle mass may be effective in preventing vertebral collapse after VCF.

ACKNOWLEDGMENTS

The authors thank all patients who agreed to participate in this study.

CONFLICTS OF INTEREST

The authors declare no conflict of interest.

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