1097. Is early bisphosphonate treatment safe or effective for pyogenic vertebral osteomyelitis with osteoporosis?
Session: Poster Abstract Session: Enteric Infections
Friday, October 5, 2018
Room: S Poster Hall

Background: Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis.

Methods: A retrospective case review was performed on PVO patients with osteoporosis. PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis); group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used to evaluate long-term effectiveness and safety of bisphosphonate in PVO patients, and event of interests included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death.

Results: A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A PVO patients had significantly lower hazard ratios for undergoing later (more than 6 weeks after diagnosis) surgery than group C PVO patients (p=0.014 for model 1 and 2) (Figure 1) despite similar occurrences of overall surgery. Significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p=0.001 for model 1 and p=0.002 for model 2), and group A and B PVO patients had significantly lower hazard ratios for subsequent fracture than group C PVO patients (Figure 2). There were no significant differences in the hazard ratios of recurrence and death among the three groups.

Conclusion: Early bisphosphonate treatment in PVO patients with osteoporosis was associated with significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies, and lower occurrence of later surgery.


Figure 1. Cumulative probability of surgery according to the treatment group. a) surgery free survival for overall surgery, b) surgery free survival for later surgery

Figure 2. Cumulative probability of subsequent fracture on adjacent vertebral bodies.

Jihye Kim, Doctor, Division of Infection, Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine,, Seoul, Korea, Republic of (South) and Tae-Hwan Kim, Professor, Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea, Republic of (South)

Disclosures:

J. Kim, None

T. H. Kim, None

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