ECTS2016 ECTS 2016 Management of osteoporosis with focus on osteoporosis in men, pregnancy and patients treated with glucocorticoids (5 abstracts)
Vertebral fractures (VFX) are the most prevalent fracture associated with osteoporosis and often cause severe pain which can become chronic. VFX are associated with a high risk of further fracture, increased mortality, and reduced quality of life. Vertebroplasty and kyphoplasty are techniques involving the percutaneous injection of bone cement into one or more symptomatic fractured vertebrae. In vertebroplasty, cement is injected directly into the bone, while in kyphoplasty, cement is injected at low pressure into a cavity created by prior inflation of a balloon.
The primary aim of both techniques is to relieve pain with an additional potential outcome from kyphoplasty of restoration of vertebral height. Early open studies suggested benefit from both procedures with most subjects reporting a significant early reduction in pain. More recent randomised controlled studies and meta-analyses of both procedures have cast doubt on the initial data with little evidence of pain control superior to that associated with sham procedures or standard pain management protocols. Complications are rare but severe adverse events are described including cement extravasation and embolization. It remains unclear whether these procedures may result in an increased risk of fracture in adjacent vertebrae.
Kyphoplasty but not vertebroplasty has been shown to increase vertebral height following VFX. Studies have demonstrated an association with reduced mortality which was stronger for kyphoplasty than vertebroplasty. The mechanism for this is unknown and may be coincidental but as a consequence, meta-analyses demonstrate cost-effectiveness and guidance including from the National Institute for Health and Care Excellence recommend use in clinical practice.
Evidence that kyphoplasty and vertebroplasty achieve the primary goal of symptom relief remains limited and the optimal selection of patients and timing of treatment remains unclear. Results of current RCTs may provide clarity and help establish their role in the clinical management of patient with painful osteoporotic VFX.
14 May 2016 - 17 May 2016