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Vertebroplasty has mixed results for osteoporotic fracture

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Vertebroplasty for the treatment of acute osteoporotic vertebral fractures has some benefits over conservative treatment but also some disadvantages, a randomized controlled trial suggests.

MedWire News: Vertebroplasty (VP) for the treatment of acute osteoporotic vertebral fractures has some benefits over conservative treatment (CT) but also some disadvantages, a randomized controlled trial suggests.

The trial found that VP offered more rapid pain relief than CT but was associated with a higher incidence of new vertebral fractures, suggesting that patient selection is key to choosing the most appropriate procedure.

VT is widely used for the management of painful vertebral fractures and multiple studies support its safety and efficacy; however, two recent trials that compared VT with sham surgery found equivocal efficacy, casting doubt on the procedure.

To investigate, Jordi Blasco Andaluz (Hospital Clinic Villarroel, Barcelona, Spain) and co-authors recruited 125 patients with painful osteoporotic vertebral fractures, and randomly assigned them to undergo VT or CT.

At the 12-month follow-up, patients' self-rated pain scores (assessed on a visual analog scale) had fallen significantly from baseline in both VT and CT groups.

There was no overall difference in the magnitude of pain relief between the two treatment groups, and the proportion of patients with moderate or severe residual pain at 12 months was similar in the two groups.

However, pain scores fell more rapidly in the VT group, reaching a nadir at around 2 months, compared with around 6 months in the CT group.

Patients' self-rated quality-of-life (assessed using the Qualeffo score) also improved signficantly in both groups between baseline and 12 months. Again, the improvement occurred more quickly with VT than with CT, reaching statistical significance at 1 month and 6 months, respectively.

Of concern, the incidence of new vertebral fracture at 12 months was significantly higher with VT than CT, at 26.56% versus 13.11%. Furthermore, the proportion of new fractures that were clinical (as opposed to radiographic) was markedly higher with VT than CT, at 71% versus 9%..

This translated into a 2.78-fold higher risk for new radiologic fracture and a 25.67-fold higher risk for new clinical fractures with VT versus CT, say the authors.

"Further efforts should be addressed to the selection of patients most likely to benefit from VP with the lowest risk of complications," conclude Andaluz et al writing in the Journal of Bone and Mineral Research.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

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