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Foundation urges systematic osteoporosis management after spinal fracture surgery

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Vertebroplasty and balloon kyphoplasty are generally safe procedures that can stabilize fractures and may restore lost vertebral height, according to a literature review recently issued by a working group of the International Osteoporosis Foundation.

The International Osteoporosis Foundation (IOF) review also lists recommendations to facilitate the comparison of future studies and highlights research questions.

“Overall, [vertebroplasty] and [balloon kyphoplasty] are generally safe procedures that provide quicker pain relief, mobility recovery and in some cases vertebral height restoration than conservative medical treatment, at least in the short term,” the authors wrote. “However, the long-term benefits and safety in terms of risk of subsequent vertebral fractures have not been clearly demonstrated, and further prospective randomized studies are needed with standards for reporting.”

Further points made in the review include:

• the added benefit of injecting cement rather than a sham-controlled procedure is still contentious;
• clinical outcomes following vertebroplasty and balloon kyphoplasty appear to be dependent on the time elapsed between initial fracture and intervention; and
• incidence of new — including adjacent — vertebral fractures are similar after either vertebroplasty or balloon kyphoplasty, but longer-term data is needed.

“Referring physicians should be aware that [vertebroplasty] and [balloon kyphoplasty] are available options for the management of vertebral compression fractures, with possible clinical benefits to their patients in terms of acute pain relief and improved quality of life,” Kristina Akesson, MD, PhD, IOF fracture working group chair, stated in an IOF release. “However, longer follow-up of patients are needed to ensure the efficacy and safety of these techniques, which should not be considered as a substitute for the medical management of osteoporosis, vitally needed in these patients at high risk of other fractures.”

Reference:

• Boonen S, Wahl DA, Nauroy L, et al. Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporosis Int. 2011. doi: 10.1007/s00198-011-1639-5.

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