Introduction: Repeat spinal fractures have well associated risk factors including post-procedure activity, chronic corticosteroid use, and type 1 diabetes mellitus. However, the association between multimodal sun protection, which often comes with a frequent concern of vitamin D deficiency, and repeat spinal fractures remains uninterrogated. A lack of research may lead to inappropriate worry and avoidance of sun-protective behaviors.
Methods: A cross-sectional dataset of 116 patients with a history of one or more spine fractures was obtained from US adults who participated in the 2017 to 2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Sun-protective behaviors were defined as staying in the shade, wearing long-sleeves, and using sunscreen. Multivariate adjusted odds ratios and 95% CIs were calculated to determine the association of sun-protective behaviors with repeat spine fractures in logistic regression models, controlling for age, race, gender, smoking status, alcohol use, drug use, and body mass index (p < 0.05).
Results: A total of 22 patients (19%) reported multiple spine fractures, with 6 (5.0%) reporting 3 or more fractures. Frequent staying in the shade (odds ratio, 1.23 [95% CI, 0.94-1.68], p = 0.10) and moderate to frequent staying in the shade (odds ratio, 1.34[95% CI, 0.88-1.71], p = 0.12) suggested a relationship with increased risk for repeat fractures however neither was significant. Other sun protective behaviors such as wearing long-sleeves (odds ratio, 0.82 [95% CI, 0.29-2.02], p = 0.14) and sunscreen use (odds ratio, 0.77 [95% CI, 0.21-1.93], p = 0.19) demonstrated no association with repeat spinal fractures.
Conclusion : A growing body of reassuring evidence suggests sun protective behaviors are generally safe in healthy patients with no considerable negative associations on bone health, supported by this analysis. However, a more significantly powered study may find an association between moderate or frequent shade and repeat spinal fractures as a vulnerable group more susceptible to multifactorial risks. While current evidence supports, a reassuring lack of association between multimodal sun protection and repeat spine fractures, further research is necessary to refine recommendations for high-risk groups.
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