BACKGROUND: The incidence of osteoporotic vertebral fractures (OVCFs) has increased significantly in recent years. In order to assess osteoporotic fracture healing process, it is necessary to study the characteristics after this type of vertebral fracture. However, there are few researches on fracture healing process in severe OVCFs. We aim to investigate the histological healing process and the kinetics of bone turnover markers following severe OVCFs.

MATERIAL AND METHODS: There were 149 patients with severe OVCFs included in this study. Fasting blood samples were obtained to detect bone turnover markers levels. A transpedicular bone biopsy was performed to collect bone biopsy specimens during vertebroplasty surgery. Stratification of healing process was performed: stage I (1–3 days), stage II (4–10 days), stage III (11–20 days), stage IV (21–30 days), stage V (1–3 months), stage VI (3–6 months).

RESULTS: Quantitative analysis of bone histomorphometry showed that a large amount of necrotic bone tissue was observed in stage VI (12.92±3.66%). Bone turnover markers showed the concentration of β-isomerized C-terminal telopeptide (β-CTX) which reflects activity in osteoclast continued to increase in stage VI (0.9±0.33 ng/mL). These results differed from previous reports of other type vertebral fractures.

CONCLUSIONS: Bone histomorphometric analysis and bone turnover markers showed that severe osteoporotic vertebral compression fractures often associated with delayed union and nonunion during the healing process.

Keywords: Bone Density, Osteoporotic Fractures, Spinal Fractures, Aged, 80 and over, Alkaline Phosphatase, Biopsy, Bone Remodeling, Collagen Type I, Fracture Healing, Fractures, Compression, Necrosis, osteocalcin, Peptide Fragments, Peptides, Phosphorus, Procollagen, Spine, vertebroplasty