ArticleClinical interventions in aging2026
Diabetes, Osteosarcopenia, and Immobilization: A Novel Nomogram for Predicting Kümmell's Disease After Osteoporotic Vertebral Fractures.
Article in Clinical interventions in aging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Kümmell's disease is a severe post-traumatic vertebral osteonecrosis characterized by delayed collapse and kyphosis following osteoporotic vertebral compression fractures (OVCFs). The transition from acute fracture to nonunion remains poorly understood. Using a single-center retrospective cohort, we aimed to develop and validate a nomogram to predict Kümmell's disease in patients with acute OVCFs undergoing conservative management. Methods: We included 626 patients (aged ≥50 years) with acute or subacute OVCFs treated conservatively between January 2021 and October 2024, randomly partitioned into a training cohort (n=470) and a validation cohort (n=156). Demographic characteristics, metabolic profiles, medication history, and radiological parameters including MRI-based paraspinal muscle metrics were analyzed. LASSO regression-based feature selection identified candidate predictors from high-dimensional variables, followed by multivariate logistic regression to construct a nomogram. Results: Kümmell's disease developed in 12.6% of the training cohort and 10.9% of the validation cohort. Six independent predictors were identified. Diabetes mellitus (OR 40.61, 95% CI 7.80-211.34), prolonged bed rest >2 weeks (OR 9.69, 95% CI 3.92-23.93), and higher initial vertebral compression rate were risk factors. Anti-osteoporosis treatment (OR 0.02), higher lumbar bone mineral density, and greater relative cross-sectional area of the multifidus muscle were protective. The nomogram achieved an area under the curve of 0.938 (95% CI 0.906-0.970) in the training cohort and 0.882 (95% CI 0.784-0.980) in the validation cohort. Conclusion: This nomogram integrates metabolic, biomechanical, and pharmacological factors to predict Kümmell's disease. Prolonged bed rest was associated with increased nonunion risk, while anti-osteoporosis pharmacotherapy and multifidus muscle integrity were protective. This tool may support precision risk stratification, guiding a shift from passive observation to active intervention for high-risk patients.
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