Vertebroplasty effectively treats acute osteoporotic vertebral fractures
MedWire News: Vertebroplasty in patients with acute osteoporotic vertebral compression fractures results in quicker and greater pain relief than conservative treatment, and can be performed safely and at acceptable costs, say researchers.
"Percutaneous vertebroplasty is increasingly used for treatment of pain in patients with osteoporotic vertebral compression fractures," remark Caroline Klazen (St Elisabeth Ziekenhuis, Tilburg, The Netherlands) and colleagues.
To determine whether vertebroplasty has additional value compared with optimum pain treatment in patients with acute vertebral fractures, Klazen and team carried out an open-label prospective randomized trial in six hospitals in the Netherlands and Belgium.
The patients studied were aged 50 years or older, had vertebral compression fractures on spine radiograph, had experienced back pain for 6 weeks or less, and had a visual analog scale (VAS) pain score of 5 or more (0=no pain, 10=worst pain ever).
In total, 101 patients with persistent pain were randomly allocated to vertebroplasty and 101 to conservative treatment. At baseline, the initial mean VAS was 7.8 in the vertebroplasty group and 7.5 in the conservative treatment group.
The researchers report that vertebroplasty resulted in significantly greater pain relief than conservative treatment. Between baseline and 1 month the mean VAS score fell by 5.2 points after vertebroplasty and 2.7 points after conservative treatment. After 1 year, the mean VAS score was 5.7 points lower than baseline in the vertebroplasty group and 3.7 points lower than baseline in the conservative treatment group.
No serious complications or adverse events were reported in either treatment group.
A cost-effectiveness acceptability curve showed that if society were willing to spend €30,000 (US $39,500) or more per quality-adjusted life year gained, vertebroplasty is an acceptable treatment strategy, say Klazen et al.
Writing in The Lancet, the researchers conclude: "In a selected subgroup of patients with acute osteoporotic vertebral compression fractures and persistent pain, percutaneous vertebroplasty is effective and safe. Pain relief after the procedure is immediate, sustained for 1 year, and is significantly better than that achieved with conservative treatment, at an acceptable cost."
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By Laura Dean