The impact of body mass index on heterotopic ossification

Waleed Fouad Mourad, Satya Packianathan, Rania A. Shourbaji, Zhen Zhang, Mathew Graves, Majid A. Khan, Michael C. Baird, George Russell, Srinivasan Vijayakumar

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Abstract

Purpose: To analyze the impact of different body mass index (BMI) as a surrogate marker for heterotopic ossification (HO) in patients who underwent surgical repair (SR) for displaced acetabular fractures (DAF) followed by radiation therapy (RT). Methods and Materials: This is a single-institution retrospective study of 395 patients. All patients underwent SR for DAF followed by RT ± indomethacin. All patients received postoperative RT, 7 Gy, within 72 h. The patients were separated into four groups based on their BMI: <18.5, 18.5-24.9, 25-29.9, and >30. The end point of this study was to evaluate the efficacy of RT ± indomethacin in preventing HO in patients with different BMI. Results: Analysis of BMI showed an increasing incidence of HO with increasing BMI: <18.5, (0%) 0/6 patients; 18.5-24.9 (6%), 6 of 105 patients developed HO; 25-29.9 (19%), 22 of 117; >30 (31%), 51 of 167. Chi-square and multivariate logistic regression analysis showed that the correlation between odds of HO and BMI is significant, p < 0.0001. As the BMI increased, the risk of HO and Brooker Classes 3, 4 HO increased. The risk of developing HO is 1.0× (10%) more likely among those with higher BMI compared with those with lower BMI. For a one-unit increase in BMI the log odds of HO increases by 1.0, 95% CI (1.06-1.14). Chi-square test shows no significant difference among all other factors and HO (e.g., indomethacin, race, gender). Conclusions: Despite similar surgical treatment and prophylactic measures (RT ± indomethacin), the risk of HO appears to significantly increase in patients with higher BMI after DAF. Higher single-fraction doses or multiple fractions and/or combination therapy with nonsteroidal inflammatory drugs may be of greater benefit to these patients.

Original languageEnglish (US)
Pages (from-to)e831-e836
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
Publication statusPublished - Apr 1 2012

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Keywords

  • Body mass index (BMI)
  • Displaced traumatic acetabular fracture
  • Heterotopic ossification radiation prophylaxis
  • Prophylactic radiation therapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Mourad, W. F., Packianathan, S., Shourbaji, R. A., Zhang, Z., Graves, M., Khan, M. A., ... Vijayakumar, S. (2012). The impact of body mass index on heterotopic ossification. International Journal of Radiation Oncology Biology Physics, 82(5), e831-e836. https://doi.org/10.1016/j.ijrobp.2011.11.033