{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:31Z","timestamp":1780736491597,"version":"3.54.1"},"reference-count":92,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to determine independent risk factors for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) in metastatic spine disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients treated with SBRT for spinal metastasis at a single tertiary care center between 2008 and 2019 were retrospectively identified. Patients with CT scans obtained within 1 year of SBRT completion were included. Variables collected included demographics, Spine Instability Neoplastic Score (SINS), primary tumor pathology, Weinstein-Boriani-Biagini (WBB) classification, chemoradiation treatment details, and bone quality as assessed by Hounsfield units (HUs) on CT. HUs were measured for the medullary bone of the metastatic level, the tumor, and the vertebral bodies cephalad and caudal to the metastasis. Multivariable logistic regression was used to identify predictors of post-SBRT pathological fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 292 patients (mean age 66 years) with 392 unique lesions were included. The most common pathologies were prostate (n = 193), kidney\/renal cell (n = 46), and lung (n = 33). The most common tumor levels were thoracic (n = 206 lesions) and lumbar (n = 128 lesions). SBRT was generally delivered in 1\u20133 fractions with doses ranging from 16 to 24 Gy in 1 fraction and 24\u201336 Gy in 3 fractions. Of the 392 lesions, 73 suffered VCF: 21 (29%) with &lt; 25% height loss, 15 (21%) with 25%\u201340% height loss, and 37 (51%) with &gt; 40% height loss. On univariate analysis, patients with VCF had lower average HUs (156 \u00b1 52 vs 202 \u00b1 89, p &lt; 0.001), more WBB sectors involved (3 \u00b1 2 vs 3 \u00b1 1, p &lt; 0.001), higher SINSs (8 \u00b1 3 vs 6 \u00b1 2, p &lt; 0.001), were more commonly female (33% vs 22%, p = 0.05), and more commonly had nonprostate pathology (67% vs 47%, p = 0.003). VCF rates were similar between moderate (&lt; 20 Gy in 1 fraction, &lt; 30 Gy in 3 or 5 fractions) and high-dose (&gt; 20 Gy in 1 fraction, &gt; 30 Gy in 3 or 5 fractions) radiation schema (15% VCF vs 16% no VCF, respectively; p = 0.99). On multivariable logistic regression, independently significant predictors of VCF were HUs \u2264 229 (OR 6, p &lt; 0.001), affected levels \u2265 3 WBB segments (OR 3, p &lt; 0.001), and an SINS \u2265 8 (OR 2, p = 0.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Low pre-radiation HUs, involvement of more WBB sectors, and a higher SINS were independent predictors of VCF following SBRT for metastatic spine disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24905","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:26Z","timestamp":1746081566000},"page":"E13","source":"Crossref","is-referenced-by-count":3,"title":["Risk factors for early pathological fracture following stereotactic body radiation therapy for spinal metastases"],"prefix":"10.3171","volume":"58","author":[{"given":"Juliana C.","family":"Capp","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Hamouda","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Mikula","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun S.","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett A.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Mohammed","family":"Karim","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nassr","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy L.","family":"Fogelson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman O.","family":"Kowalchuk","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W.","family":"Merrell","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Nucl Med Rev Cent East Eur","first-page":"66","article-title":"Pattern and distribution of bone metastases in common malignant tumors","volume":"16","author":"Kakhki VR","year":"2013","unstructured":"Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M. Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev Cent East Eur. 2013;16(2):66\u201369."},{"issue":"suppl 1","key":"b2","series-title":"Neurooncol Pract","first-page":"i5","article-title":"Epidemiology of spinal cord and column tumors","volume":"7","author":"Wewel JT","year":"2020","unstructured":"Wewel JT, O\u2019Toole JE. Epidemiology of spinal cord and column tumors. Neurooncol Pract. 2020;7(suppl 1):i5-i9."},{"issue":"6","key":"b3","series-title":"Cancer","first-page":"956","article-title":"Development and validation of a recursive partitioning analysis-based pretreatment decision-making tool identifying ideal candidates for spine stereotactic body radiation therapy","volume":"129","author":"Kowalchuk RO","year":"2023","unstructured":"Kowalchuk RO, Mullikin TC, Florez M,  Development and validation of a recursive partitioning analysis-based pretreatment decision-making tool identifying ideal candidates for spine stereotactic body radiation therapy. Cancer. 2023;129(6):956\u2013965."},{"issue":"3","key":"b4","series-title":"Pract Radiat Oncol","first-page":"236","article-title":"Cost-effectiveness of treatment strategies for spinal metastases","volume":"12","author":"Kowalchuk RO","year":"2022","unstructured":"Kowalchuk RO, Mullikin TC, Kim DK,  Cost-effectiveness of treatment strategies for spinal metastases. Pract Radiat Oncol. 2022;12(3):236\u2013244."},{"issue":"4","key":"b5","series-title":"J Radiosurg SBRT","first-page":"297","article-title":"Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: a multi-institutional study","volume":"3","author":"Thibault I","year":"2015","unstructured":"Thibault I, Atenafu EG, Chang E,  Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: a multi-institutional study. J Radiosurg SBRT. 2015;3(4):297\u2013305."},{"issue":"5","key":"b6","series-title":"Clin Oncol (R Coll Radiol)","first-page":"298","article-title":"Stereotactic body radiotherapy for spinal and bone metastases","volume":"27","author":"Bhattacharya IS","year":"2015","unstructured":"Bhattacharya IS, Hoskin PJ. Stereotactic body radiotherapy for spinal and bone metastases. Clin Oncol (R Coll Radiol). 2015;27(5):298\u2013306."},{"issue":"5","key":"b7","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1397","article-title":"CCTG SC.24\/TROG 17.06: A randomized phase II\/III study comparing 24Gy in 2 stereotactic body radiotherapy (SBRT) fractions versus 20Gy in 5 conventional palliative radiotherapy (CRT) fractions for patients with painful spinal metastases","volume":"108","author":"Sahgal A","year":"2020","unstructured":"Sahgal A, Myrehaug SD, Siva S,  CCTG SC.24\/TROG 17.06: A randomized phase II\/III study comparing 24Gy in 2 stereotactic body radiotherapy (SBRT) fractions versus 20Gy in 5 conventional palliative radiotherapy (CRT) fractions for patients with painful spinal metastases. Int J Radiat Oncol Biol Phys. 2020;108(5):1397\u20131398."},{"issue":"6","key":"b8","series-title":"JAMA Oncol","first-page":"872","article-title":"Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial","volume":"5","author":"Nguyen QN","year":"2019","unstructured":"Nguyen QN, Chun SG, Chow E,  Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial. JAMA Oncol. 2019;5(6):872\u2013878."},{"issue":"42","key":"b9","series-title":"Health Technol Assess","first-page":"1","article-title":"A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression","volume":"17","author":"Sutcliffe P","year":"2013","unstructured":"Sutcliffe P, Connock M, Shyangdan D, Court R, Kandala NB, Clarke A. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess. 2013;17(42):1\u2013274."},{"issue":"4","key":"b10","series-title":"J Neurosurg Spine","first-page":"617","article-title":"Independent predictors of vertebral compression fracture following radiation for metastatic spine disease","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Pennington Z, Lakomkin N,  Independent predictors of vertebral compression fracture following radiation for metastatic spine disease. J Neurosurg Spine. 2022;37(4):617\u2013623."},{"issue":"6","key":"b11","series-title":"J Neurosurg Spine","first-page":"928","article-title":"Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation","volume":"24","author":"Jawad MS","year":"2016","unstructured":"Jawad MS, Fahim DK, Gerszten PC,  Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation. J Neurosurg Spine. 2016;24(6):928\u2013936."},{"issue":"6","key":"b12","series-title":"J Neurosurg Spine","first-page":"870","article-title":"Vertebral body fracture rates after stereotactic body radiation therapy compared with external-beam radiation therapy for metastatic spine tumors","volume":"33","author":"Vargas E","year":"2020","unstructured":"Vargas E, Susko MS, Mummaneni PV, Braunstein SE, Chou D. Vertebral body fracture rates after stereotactic body radiation therapy compared with external-beam radiation therapy for metastatic spine tumors. J Neurosurg Spine. 2020;33(6):870\u2013876."},{"issue":"27","key":"b13","series-title":"J Clin Oncol","first-page":"3426","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Atenafu EG, Chao S,  Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol. 2013;31(27):3426\u20133431."},{"issue":"4","key":"b14","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling NS","year":"2012","unstructured":"Boehling NS, Grosshans DR, Allen PK,  Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine. 2012;16(4):379\u2013386."},{"issue":"3","key":"b15","series-title":"JAMA Oncol","first-page":"412","article-title":"Development and assessment of a predictive score for vertebral compression fracture after stereotactic body radiation therapy for spinal metastases","volume":"8","author":"Kowalchuk RO","year":"2022","unstructured":"Kowalchuk RO, Johnson-Tesch BA, Marion JT,  Development and assessment of a predictive score for vertebral compression fracture after stereotactic body radiation therapy for spinal metastases. JAMA Oncol. 2022;8(3):412\u2013419."},{"issue":"1","key":"b16","series-title":"J Neurosurg Spine","first-page":"19","article-title":"Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy","volume":"40","author":"Pennington Z","year":"2023","unstructured":"Pennington Z, Mikula AL, Lakomkin N,  Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy. J Neurosurg Spine. 2023;40(1):19\u201327."},{"issue":"9","key":"b17","series-title":"J Bone Miner Res","first-page":"1137","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant HK","year":"1993","unstructured":"Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137\u20131148."},{"issue":"5","key":"b18","series-title":"J Neurosurg Spine","first-page":"694","article-title":"Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Lakomkin N, Pennington Z,  Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine. J Neurosurg Spine. 2022;37(5):694\u2013702."},{"issue":"11","key":"b19","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"7041","key":"b20","series-title":"BMJ","first-page":"1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall D","year":"1996","unstructured":"Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254\u20131259."},{"issue":"2","key":"b21","series-title":"Spine J","first-page":"321","article-title":"Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives","volume":"21","author":"Pennington Z","year":"2021","unstructured":"Pennington Z, Ehresman J, Lubelski D,  Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives. Spine J. 2021;21(2):321\u2013331."},{"issue":"14","key":"b22","first-page":"1021","article-title":"Opportunistic CT-based Hounsfield units strongly correlate with biomechanical CT measurements in the thoracolumbar spine","volume":"49","author":"Martini ML","year":"2024","unstructured":"Martini ML, Mikula AL, Lakomkin N,  Opportunistic CT-based Hounsfield units strongly correlate with biomechanical CT measurements in the thoracolumbar spine. Spine (Phila Pa 1976). 2024;49(14):1021\u20131028."},{"issue":"5","key":"b23","series-title":"J Neurosurg Spine","first-page":"611","article-title":"Risk factors for sacral fracture following en bloc chordoma resection","volume":"39","author":"Mikula AL","year":"2023","unstructured":"Mikula AL, Pennington Z, Lakomkin N,  Risk factors for sacral fracture following en bloc chordoma resection. J Neurosurg Spine. 2023;39(5):611\u2013617."},{"issue":"9","key":"b24","series-title":"J Bone Miner Res","first-page":"1628","article-title":"Trabecular bone structure analysis in the osteoporotic spine using a clinical in vivo setup for 64-slice MDCT imaging: comparison to microCT imaging and microFE modeling","volume":"24","author":"Issever AS","year":"2009","unstructured":"Issever AS, Link TM, Kentenich M,  Trabecular bone structure analysis in the osteoporotic spine using a clinical in vivo setup for 64-slice MDCT imaging: comparison to microCT imaging and microFE modeling. J Bone Miner Res. 2009;24(9):1628\u20131637."},{"issue":"4","key":"b25","series-title":"J Neurosurg Spine","first-page":"499","article-title":"A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis","volume":"32","author":"Ehresman J","year":"2019","unstructured":"Ehresman J, Schilling A, Pennington Z,  A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurg Spine. 2019;32(4):499\u2013506."},{"issue":"7","key":"b26","series-title":"Lancet Oncol","first-page":"1023","article-title":"Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2\/3 trial","volume":"22","author":"Sahgal A","year":"2021","unstructured":"Sahgal A, Myrehaug SD, Siva S,  Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2\/3 trial. Lancet Oncol. 2021;22(7):1023\u20131033."},{"key":"b27","series-title":"Cancer Treat Rev","first-page":"57","article-title":"Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody","volume":"76","author":"von Moos R","year":"2019","unstructured":"von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ. Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody. Cancer Treat Rev. 2019;76:57\u201367."},{"issue":"12","key":"b28","series-title":"Ann Oncol","first-page":"1650","article-title":"Bone health in cancer: ESMO Clinical Practice Guidelines","volume":"31","author":"Coleman R","year":"2020","unstructured":"Coleman R, Hadji P, Body JJ,  Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1650\u20131663."},{"issue":"2","key":"b29","first-page":"128","article-title":"Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction","volume":"47","author":"Sardar ZM","year":"2022","unstructured":"Sardar ZM, Coury JR, Cerpa M,  Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction. Spine (Phila Pa 1976). 2022;47(2):128\u2013135."},{"issue":"2","key":"b30","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment","volume":"49","author":"Flanigan PM","year":"2020","unstructured":"Flanigan PM, Mikula AL, Peters PA,  Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment. Neurosurg Focus. 2020;49(2):E11."},{"key":"b31","article-title":"US FDA","author":"TYMLOS label","unstructured":"TYMLOS label. US FDA. Accessed March 10, 2025. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/208743lbl.pdf"},{"issue":"9","key":"b32","series-title":"JBMR Plus","first-page":"e10665","article-title":"Teriparatide and osteosarcoma risk: history, science, elimination of boxed warning, and other label updates","volume":"6","author":"Krege JH","year":"2022","unstructured":"Krege JH, Gilsenan AW, Komacko JL, Kellier-Steele N. Teriparatide and osteosarcoma risk: history, science, elimination of boxed warning, and other label updates. JBMR Plus. 2022;6(9):e10665."},{"issue":"10","key":"b33","series-title":"J Am Acad Orthop Surg","first-page":"520","article-title":"Treatment of osteoporosis with anabolic agents and the risk of primary bone cancers: a study of 44,728 patients treated with teriparatide and abaloparatide","volume":"31","author":"McDonald CL","year":"2023","unstructured":"McDonald CL, Johnson K, Alsoof D, Molino J, Balmaceno-Criss M, Daniels AH. Treatment of osteoporosis with anabolic agents and the risk of primary bone cancers: a study of 44,728 patients treated with teriparatide and abaloparatide. J Am Acad Orthop Surg. 2023;31(10):520\u2013528."},{"issue":"1","key":"b34","series-title":"Sci Rep","first-page":"11801","article-title":"Denosumab versus romosozumab for postmenopausal osteoporosis treatment","volume":"11","author":"Kobayakawa T","year":"2021","unstructured":"Kobayakawa T, Miyazaki A, Saito M, Suzuki T, Takahashi J, Nakamura Y. Denosumab versus romosozumab for postmenopausal osteoporosis treatment. Sci Rep. 2021;11(1):11801."},{"issue":"11","key":"b35","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review","volume":"16","author":"Health Quality Ontario","year":"2016","unstructured":"Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1\u2013202."},{"issue":"1","key":"b36","series-title":"Int J Radiat Oncol Biol Phys","first-page":"83","article-title":"A phase 2 clinical trial of SABR followed by immediate vertebroplasty for spine metastases","volume":"104","author":"Wardak Z","year":"2019","unstructured":"Wardak Z, Bland R, Ahn C,  A phase 2 clinical trial of SABR followed by immediate vertebroplasty for spine metastases. Int J Radiat Oncol Biol Phys. 2019;104(1):83\u201389."},{"key":"b37","series-title":"OncoTargets Ther","first-page":"2139","article-title":"Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC","volume":"8","author":"Li Y","year":"2015","unstructured":"Li Y, Qing Y, Zhang Z,  Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC. OncoTargets Ther. 2015;8:2139\u20132145."},{"issue":"20 Suppl","key":"b38","series-title":"Spine (Phila Pa 1976)","first-page":"S238","article-title":"Stereotactic body radiotherapy for spinal metastases: what are the risks and how do we minimize them?","volume":"41 Suppl 20","author":"Chang JH","year":"2016","unstructured":"Chang JH, Shin JH, Yamada YJ,  Stereotactic body radiotherapy for spinal metastases: what are the risks and how do we minimize them? Spine (Phila Pa 1976). 2016;41 Suppl 20(20 Suppl):S238-S245."},{"issue":"8","key":"b39","series-title":"Lancet Oncol","first-page":"e310","article-title":"Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases","volume":"14","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol. 2013;14(8):e310\u2013e320."},{"issue":"3","key":"b40","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha MV","year":"2012","unstructured":"Cunha MV, Al-Omair A, Atenafu EG,  Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys. 2012;84(3):e343\u2013e349."},{"issue":"30","key":"b41","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose PS","year":"2009","unstructured":"Rose PS, Laufer I, Boland PJ,  Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol. 2009;27(30):5075\u20135079."},{"issue":"4","key":"b42","series-title":"Neurosurgery","first-page":"813","article-title":"30 Gy in 4 stereotactic body radiotherapy fractions for complex spinal metastases: mature outcomes supporting this novel regimen","volume":"93","author":"Moore-Palhares D","year":"2023","unstructured":"Moore-Palhares D, Sahgal A, Zeng KL,  30 Gy in 4 stereotactic body radiotherapy fractions for complex spinal metastases: mature outcomes supporting this novel regimen. Neurosurgery. 2023;93(4):813\u2013823."},{"issue":"2","key":"b43","series-title":"Int J Radiat Oncol Biol Phys","first-page":"528","article-title":"Effects of single-dose versus hypofractionated focused radiation on vertebral body structure and biomechanical integrity: development of a rabbit radiation-induced vertebral compression fracture model","volume":"111","author":"Perdomo-Pantoja A","year":"2021","unstructured":"Perdomo-Pantoja A, Holmes C, Lina IA,  Effects of single-dose versus hypofractionated focused radiation on vertebral body structure and biomechanical integrity: development of a rabbit radiation-induced vertebral compression fracture model. Int J Radiat Oncol Biol Phys. 2021;111(2):528\u2013538."},{"issue":"6","key":"b44","series-title":"Adv Radiat Oncol","first-page":"101047","article-title":"Single and multifraction spine stereotactic body radiation therapy and the risk of radiation induced myelopathy","volume":"7","author":"Lucido JJ","year":"2022","unstructured":"Lucido JJ, Mullikin TC, Abraha F,  Single and multifraction spine stereotactic body radiation therapy and the risk of radiation induced myelopathy. Adv Radiat Oncol. 2022;7(6):101047."},{"issue":"14","key":"b45","series-title":"Cancer Med","first-page":"6176","article-title":"Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: a systematic review","volume":"8","author":"Gong Y","year":"2019","unstructured":"Gong Y, Xu L, Zhuang H,  Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: a systematic review. Cancer Med. 2019;8(14):6176\u20136184."},{"issue":"19","key":"b46","series-title":"J Natl Cancer Inst","first-page":"1458","article-title":"A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma","volume":"94","author":"Saad F","year":"2002","unstructured":"Saad F, Gleason DM, Murray R,  A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002;94(19):1458\u20131468."},{"issue":"2","key":"b1","series-title":"Nucl Med Rev Cent East Eur","first-page":"66","article-title":"Pattern and distribution of bone metastases in common malignant tumors","volume":"16","author":"Kakhki VR","year":"2013","unstructured":"Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M. Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev Cent East Eur. 2013;16(2):66\u201369."},{"issue":"suppl 1","key":"b2","series-title":"Neurooncol Pract","first-page":"i5","article-title":"Epidemiology of spinal cord and column tumors","volume":"7","author":"Wewel JT","year":"2020","unstructured":"Wewel JT, O\u2019Toole JE. Epidemiology of spinal cord and column tumors. Neurooncol Pract. 2020;7(suppl 1):i5-i9."},{"issue":"6","key":"b3","series-title":"Cancer","first-page":"956","article-title":"Development and validation of a recursive partitioning analysis-based pretreatment decision-making tool identifying ideal candidates for spine stereotactic body radiation therapy","volume":"129","author":"Kowalchuk RO","year":"2023","unstructured":"Kowalchuk RO, Mullikin TC, Florez M,  Development and validation of a recursive partitioning analysis-based pretreatment decision-making tool identifying ideal candidates for spine stereotactic body radiation therapy. Cancer. 2023;129(6):956\u2013965."},{"issue":"3","key":"b4","series-title":"Pract Radiat Oncol","first-page":"236","article-title":"Cost-effectiveness of treatment strategies for spinal metastases","volume":"12","author":"Kowalchuk RO","year":"2022","unstructured":"Kowalchuk RO, Mullikin TC, Kim DK,  Cost-effectiveness of treatment strategies for spinal metastases. Pract Radiat Oncol. 2022;12(3):236\u2013244."},{"issue":"4","key":"b5","series-title":"J Radiosurg SBRT","first-page":"297","article-title":"Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: a multi-institutional study","volume":"3","author":"Thibault I","year":"2015","unstructured":"Thibault I, Atenafu EG, Chang E,  Risk of vertebral compression fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy: a multi-institutional study. J Radiosurg SBRT. 2015;3(4):297\u2013305."},{"issue":"5","key":"b6","series-title":"Clin Oncol (R Coll Radiol)","first-page":"298","article-title":"Stereotactic body radiotherapy for spinal and bone metastases","volume":"27","author":"Bhattacharya IS","year":"2015","unstructured":"Bhattacharya IS, Hoskin PJ. Stereotactic body radiotherapy for spinal and bone metastases. Clin Oncol (R Coll Radiol). 2015;27(5):298\u2013306."},{"issue":"5","key":"b7","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1397","article-title":"CCTG SC.24\/TROG 17.06: A randomized phase II\/III study comparing 24Gy in 2 stereotactic body radiotherapy (SBRT) fractions versus 20Gy in 5 conventional palliative radiotherapy (CRT) fractions for patients with painful spinal metastases","volume":"108","author":"Sahgal A","year":"2020","unstructured":"Sahgal A, Myrehaug SD, Siva S,  CCTG SC.24\/TROG 17.06: A randomized phase II\/III study comparing 24Gy in 2 stereotactic body radiotherapy (SBRT) fractions versus 20Gy in 5 conventional palliative radiotherapy (CRT) fractions for patients with painful spinal metastases. Int J Radiat Oncol Biol Phys. 2020;108(5):1397\u20131398."},{"issue":"6","key":"b8","series-title":"JAMA Oncol","first-page":"872","article-title":"Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial","volume":"5","author":"Nguyen QN","year":"2019","unstructured":"Nguyen QN, Chun SG, Chow E,  Single-fraction stereotactic vs conventional multifraction radiotherapy for pain relief in patients with predominantly nonspine bone metastases: a randomized phase 2 trial. JAMA Oncol. 2019;5(6):872\u2013878."},{"issue":"42","key":"b9","series-title":"Health Technol Assess","first-page":"1","article-title":"A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression","volume":"17","author":"Sutcliffe P","year":"2013","unstructured":"Sutcliffe P, Connock M, Shyangdan D, Court R, Kandala NB, Clarke A. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess. 2013;17(42):1\u2013274."},{"issue":"4","key":"b10","series-title":"J Neurosurg Spine","first-page":"617","article-title":"Independent predictors of vertebral compression fracture following radiation for metastatic spine disease","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Pennington Z, Lakomkin N,  Independent predictors of vertebral compression fracture following radiation for metastatic spine disease. J Neurosurg Spine. 2022;37(4):617\u2013623."},{"issue":"6","key":"b11","series-title":"J Neurosurg Spine","first-page":"928","article-title":"Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation","volume":"24","author":"Jawad MS","year":"2016","unstructured":"Jawad MS, Fahim DK, Gerszten PC,  Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation. J Neurosurg Spine. 2016;24(6):928\u2013936."},{"issue":"6","key":"b12","series-title":"J Neurosurg Spine","first-page":"870","article-title":"Vertebral body fracture rates after stereotactic body radiation therapy compared with external-beam radiation therapy for metastatic spine tumors","volume":"33","author":"Vargas E","year":"2020","unstructured":"Vargas E, Susko MS, Mummaneni PV, Braunstein SE, Chou D. Vertebral body fracture rates after stereotactic body radiation therapy compared with external-beam radiation therapy for metastatic spine tumors. J Neurosurg Spine. 2020;33(6):870\u2013876."},{"issue":"27","key":"b13","series-title":"J Clin Oncol","first-page":"3426","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Atenafu EG, Chao S,  Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol. 2013;31(27):3426\u20133431."},{"issue":"4","key":"b14","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling NS","year":"2012","unstructured":"Boehling NS, Grosshans DR, Allen PK,  Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine. 2012;16(4):379\u2013386."},{"issue":"3","key":"b15","series-title":"JAMA Oncol","first-page":"412","article-title":"Development and assessment of a predictive score for vertebral compression fracture after stereotactic body radiation therapy for spinal metastases","volume":"8","author":"Kowalchuk RO","year":"2022","unstructured":"Kowalchuk RO, Johnson-Tesch BA, Marion JT,  Development and assessment of a predictive score for vertebral compression fracture after stereotactic body radiation therapy for spinal metastases. JAMA Oncol. 2022;8(3):412\u2013419."},{"issue":"1","key":"b16","series-title":"J Neurosurg Spine","first-page":"19","article-title":"Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy","volume":"40","author":"Pennington Z","year":"2023","unstructured":"Pennington Z, Mikula AL, Lakomkin N,  Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy. J Neurosurg Spine. 2023;40(1):19\u201327."},{"issue":"9","key":"b17","series-title":"J Bone Miner Res","first-page":"1137","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant HK","year":"1993","unstructured":"Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137\u20131148."},{"issue":"5","key":"b18","series-title":"J Neurosurg Spine","first-page":"694","article-title":"Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine","volume":"37","author":"Mikula AL","year":"2022","unstructured":"Mikula AL, Lakomkin N, Pennington Z,  Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine. J Neurosurg Spine. 2022;37(5):694\u2013702."},{"issue":"11","key":"b19","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063."},{"issue":"7041","key":"b20","series-title":"BMJ","first-page":"1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall D","year":"1996","unstructured":"Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254\u20131259."},{"issue":"2","key":"b21","series-title":"Spine J","first-page":"321","article-title":"Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives","volume":"21","author":"Pennington Z","year":"2021","unstructured":"Pennington Z, Ehresman J, Lubelski D,  Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives. Spine J. 2021;21(2):321\u2013331."},{"issue":"14","key":"b22","first-page":"1021","article-title":"Opportunistic CT-based Hounsfield units strongly correlate with biomechanical CT measurements in the thoracolumbar spine","volume":"49","author":"Martini ML","year":"2024","unstructured":"Martini ML, Mikula AL, Lakomkin N,  Opportunistic CT-based Hounsfield units strongly correlate with biomechanical CT measurements in the thoracolumbar spine. Spine (Phila Pa 1976). 2024;49(14):1021\u20131028."},{"issue":"5","key":"b23","series-title":"J Neurosurg Spine","first-page":"611","article-title":"Risk factors for sacral fracture following en bloc chordoma resection","volume":"39","author":"Mikula AL","year":"2023","unstructured":"Mikula AL, Pennington Z, Lakomkin N,  Risk factors for sacral fracture following en bloc chordoma resection. J Neurosurg Spine. 2023;39(5):611\u2013617."},{"issue":"9","key":"b24","series-title":"J Bone Miner Res","first-page":"1628","article-title":"Trabecular bone structure analysis in the osteoporotic spine using a clinical in vivo setup for 64-slice MDCT imaging: comparison to microCT imaging and microFE modeling","volume":"24","author":"Issever AS","year":"2009","unstructured":"Issever AS, Link TM, Kentenich M,  Trabecular bone structure analysis in the osteoporotic spine using a clinical in vivo setup for 64-slice MDCT imaging: comparison to microCT imaging and microFE modeling. J Bone Miner Res. 2009;24(9):1628\u20131637."},{"issue":"4","key":"b25","series-title":"J Neurosurg Spine","first-page":"499","article-title":"A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis","volume":"32","author":"Ehresman J","year":"2019","unstructured":"Ehresman J, Schilling A, Pennington Z,  A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurg Spine. 2019;32(4):499\u2013506."},{"issue":"7","key":"b26","series-title":"Lancet Oncol","first-page":"1023","article-title":"Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2\/3 trial","volume":"22","author":"Sahgal A","year":"2021","unstructured":"Sahgal A, Myrehaug SD, Siva S,  Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2\/3 trial. Lancet Oncol. 2021;22(7):1023\u20131033."},{"key":"b27","series-title":"Cancer Treat Rev","first-page":"57","article-title":"Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody","volume":"76","author":"von Moos R","year":"2019","unstructured":"von Moos R, Costa L, Gonzalez-Suarez E, Terpos E, Niepel D, Body JJ. Management of bone health in solid tumours: from bisphosphonates to a monoclonal antibody. Cancer Treat Rev. 2019;76:57\u201367."},{"issue":"12","key":"b28","series-title":"Ann Oncol","first-page":"1650","article-title":"Bone health in cancer: ESMO Clinical Practice Guidelines","volume":"31","author":"Coleman R","year":"2020","unstructured":"Coleman R, Hadji P, Body JJ,  Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2020;31(12):1650\u20131663."},{"issue":"2","key":"b29","first-page":"128","article-title":"Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction","volume":"47","author":"Sardar ZM","year":"2022","unstructured":"Sardar ZM, Coury JR, Cerpa M,  Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction. Spine (Phila Pa 1976). 2022;47(2):128\u2013135."},{"issue":"2","key":"b30","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment","volume":"49","author":"Flanigan PM","year":"2020","unstructured":"Flanigan PM, Mikula AL, Peters PA,  Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment. Neurosurg Focus. 2020;49(2):E11."},{"key":"b31","article-title":"US FDA","author":"TYMLOS label","unstructured":"TYMLOS label. US FDA. Accessed March 10, 2025. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/208743lbl.pdf"},{"issue":"9","key":"b32","series-title":"JBMR Plus","first-page":"e10665","article-title":"Teriparatide and osteosarcoma risk: history, science, elimination of boxed warning, and other label updates","volume":"6","author":"Krege JH","year":"2022","unstructured":"Krege JH, Gilsenan AW, Komacko JL, Kellier-Steele N. Teriparatide and osteosarcoma risk: history, science, elimination of boxed warning, and other label updates. JBMR Plus. 2022;6(9):e10665."},{"issue":"10","key":"b33","series-title":"J Am Acad Orthop Surg","first-page":"520","article-title":"Treatment of osteoporosis with anabolic agents and the risk of primary bone cancers: a study of 44,728 patients treated with teriparatide and abaloparatide","volume":"31","author":"McDonald CL","year":"2023","unstructured":"McDonald CL, Johnson K, Alsoof D, Molino J, Balmaceno-Criss M, Daniels AH. Treatment of osteoporosis with anabolic agents and the risk of primary bone cancers: a study of 44,728 patients treated with teriparatide and abaloparatide. J Am Acad Orthop Surg. 2023;31(10):520\u2013528."},{"issue":"1","key":"b34","series-title":"Sci Rep","first-page":"11801","article-title":"Denosumab versus romosozumab for postmenopausal osteoporosis treatment","volume":"11","author":"Kobayakawa T","year":"2021","unstructured":"Kobayakawa T, Miyazaki A, Saito M, Suzuki T, Takahashi J, Nakamura Y. Denosumab versus romosozumab for postmenopausal osteoporosis treatment. Sci Rep. 2021;11(1):11801."},{"issue":"11","key":"b35","series-title":"Ont Health Technol Assess Ser","first-page":"1","article-title":"Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review","volume":"16","author":"Health Quality Ontario","year":"2016","unstructured":"Health Quality Ontario. Vertebral augmentation involving vertebroplasty or kyphoplasty for cancer-related vertebral compression fractures: a systematic review. Ont Health Technol Assess Ser. 2016;16(11):1\u2013202."},{"issue":"1","key":"b36","series-title":"Int J Radiat Oncol Biol Phys","first-page":"83","article-title":"A phase 2 clinical trial of SABR followed by immediate vertebroplasty for spine metastases","volume":"104","author":"Wardak Z","year":"2019","unstructured":"Wardak Z, Bland R, Ahn C,  A phase 2 clinical trial of SABR followed by immediate vertebroplasty for spine metastases. Int J Radiat Oncol Biol Phys. 2019;104(1):83\u201389."},{"key":"b37","series-title":"OncoTargets Ther","first-page":"2139","article-title":"Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC","volume":"8","author":"Li Y","year":"2015","unstructured":"Li Y, Qing Y, Zhang Z,  Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC. OncoTargets Ther. 2015;8:2139\u20132145."},{"issue":"20 Suppl","key":"b38","series-title":"Spine (Phila Pa 1976)","first-page":"S238","article-title":"Stereotactic body radiotherapy for spinal metastases: what are the risks and how do we minimize them?","volume":"41 Suppl 20","author":"Chang JH","year":"2016","unstructured":"Chang JH, Shin JH, Yamada YJ,  Stereotactic body radiotherapy for spinal metastases: what are the risks and how do we minimize them? Spine (Phila Pa 1976). 2016;41 Suppl 20(20 Suppl):S238-S245."},{"issue":"8","key":"b39","series-title":"Lancet Oncol","first-page":"e310","article-title":"Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases","volume":"14","author":"Sahgal A","year":"2013","unstructured":"Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol. 2013;14(8):e310\u2013e320."},{"issue":"3","key":"b40","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha MV","year":"2012","unstructured":"Cunha MV, Al-Omair A, Atenafu EG,  Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys. 2012;84(3):e343\u2013e349."},{"issue":"30","key":"b41","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose PS","year":"2009","unstructured":"Rose PS, Laufer I, Boland PJ,  Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol. 2009;27(30):5075\u20135079."},{"issue":"4","key":"b42","series-title":"Neurosurgery","first-page":"813","article-title":"30 Gy in 4 stereotactic body radiotherapy fractions for complex spinal metastases: mature outcomes supporting this novel regimen","volume":"93","author":"Moore-Palhares D","year":"2023","unstructured":"Moore-Palhares D, Sahgal A, Zeng KL,  30 Gy in 4 stereotactic body radiotherapy fractions for complex spinal metastases: mature outcomes supporting this novel regimen. Neurosurgery. 2023;93(4):813\u2013823."},{"issue":"2","key":"b43","series-title":"Int J Radiat Oncol Biol Phys","first-page":"528","article-title":"Effects of single-dose versus hypofractionated focused radiation on vertebral body structure and biomechanical integrity: development of a rabbit radiation-induced vertebral compression fracture model","volume":"111","author":"Perdomo-Pantoja A","year":"2021","unstructured":"Perdomo-Pantoja A, Holmes C, Lina IA,  Effects of single-dose versus hypofractionated focused radiation on vertebral body structure and biomechanical integrity: development of a rabbit radiation-induced vertebral compression fracture model. Int J Radiat Oncol Biol Phys. 2021;111(2):528\u2013538."},{"issue":"6","key":"b44","series-title":"Adv Radiat Oncol","first-page":"101047","article-title":"Single and multifraction spine stereotactic body radiation therapy and the risk of radiation induced myelopathy","volume":"7","author":"Lucido JJ","year":"2022","unstructured":"Lucido JJ, Mullikin TC, Abraha F,  Single and multifraction spine stereotactic body radiation therapy and the risk of radiation induced myelopathy. Adv Radiat Oncol. 2022;7(6):101047."},{"issue":"14","key":"b45","series-title":"Cancer Med","first-page":"6176","article-title":"Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: a systematic review","volume":"8","author":"Gong Y","year":"2019","unstructured":"Gong Y, Xu L, Zhuang H,  Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: a systematic review. Cancer Med. 2019;8(14):6176\u20136184."},{"issue":"19","key":"b46","series-title":"J Natl Cancer Inst","first-page":"1458","article-title":"A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma","volume":"94","author":"Saad F","year":"2002","unstructured":"Saad F, Gleason DM, Murray R,  A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002;94(19):1458\u20131468."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE13.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE13.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:24:47Z","timestamp":1780734287000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE13.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":92,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2025.2.focus24905","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}