Vertebral augmentation is among the current standards of care to reduce pain in patients with vertebral fractures (VF), yet a lack of consensus regarding efficacy and safety of percutaneous vertebroplasty and kyphoplasty raises questions on what basis clinicians should choose one therapy over another. Given the lack of consensus in the field, the American Society for Bone and Mineral Research (ASBMR) leadership charged this Task Force to address key questions on the efficacy and safety of vertebral augmentation and other nonpharmacological approaches for the treatment of pain after VF. This report details the findings and recommendations of this Task Force. For patients with acutely painful VF, percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. Results did not differ according to duration of pain. There is also insufficient evidence to support kyphoplasty over nonsurgical management, percutaneous vertebroplasty, vertebral body stenting, or KIVA®. There is limited evidence to determine the risk of incident VF or serious adverse effects (AE) related to either percutaneous vertebroplasty or kyphoplasty. No recommendation can be made about harms, but they cannot be excluded. For patients with painful VF, it is unclear whether spinal bracing improves physical function, disability, or quality of life. Exercise may improve mobility and may reduce pain and fear of falling but does not reduce falls or fractures in individuals with VF. General and intervention-specific research recommendations stress the need to reduce study bias and address methodological flaws in study design and data collection. This includes the need for larger sample sizes, inclusion of a placebo control, more data on serious AE, and more research on nonpharmacologic interventions. Routine use of vertebral augmentation is not supported by current evidence. When it is offered, patients should be fully informed about the evidence. Anti-osteoporotic medications reduce the risk of subsequent vertebral fractures by 40–70%.
Bibliographical noteFunding Information:
1Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia 2Department of Clinical Sciences, Lund University, Malmo€, Sweden 3Department of Medicine, University of California, San Francisco San Francisco CA, USA 4Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash, Monash University, Melbourne, Australia 5Department of Human Metabolism, University of Sheffield, Sheffield, UK 6Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, and Department of Medicine, University of Minnesota, Minneapolis, MN, USA 7Department of Kinesiology and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Canada 8Department of Rheumatology, Hospital Clinic, University of Barcelona, Barcelona, Spain 9Department of Medicine, University of California, San Diego San Diego CA, USA 10Mayo Clinic, Rochester, MN, USA 11Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco San Francisco CA, USA 12Division of Endocrinology, Mayo Clinic, Rochester, MN, USA 13Newport News, VA, USA 14Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
© 2018 American Society for Bone and Mineral Research
Copyright 2019 Elsevier B.V., All rights reserved.
- VERTEBRAL AUGMENTATION
- VERTEBRAL FRACTURE