A nonsurgical therapy used to heal vertebral compression fractures, vertebroplasty may increase the risk of new fractures in adjacent vertebrae, according to a study in the January issue of American Journal of Neuroradiology.1 Fractures in adjacent vertebrae also occur much sooner than in more distant vertebrae, the retrospective study found.

Specifically, in an analysis of the risk and timing of subsequent fractures in 432 patients following vertebroplasty, a patient's risk for new fractures in vertebrae adjacent to those treated was 4.62 times the risk for nonadjacent vertebral fractures. In addition, the authors found that new fractures occurred in adjacent vertebrae sooner than in nonadjacent vertebrae: a median of 55 days following vertebroplasty for adjacent fractures, compared with 127 days for nonadjacent vertebral fractures (log rank <.0001). In total, 186 new fractures occurred post-vertebroplasty in 86 patients, with 77 of these fractures located in vertebrae adjacent to the vertebroplasty-treated vertebrae.

Although there is no causative relationship between vertebroplasty and subsequent vertebral fractures, the researchers speculate that the increased risk of adjacent vertebral fractures post-vertebroplasty in some patients could be due to the disruption in the biomechanics of the spine caused by the cement used in the procedure, the especially weakened nature of the bones in some patients, or the type of cement used in the procedure.

"The message for the physician is two-fold," says study author David F. Kallmes, MD, a neuroradiologist at the Mayo Clinic in Rochester, Minnesota. "One is that the jury remains out as to whether vertebroplasty actually causes new fractures, but there is a fair amount of circumstantial evidence that makes it look like it may, and we have to tell patients that," he tells CIAOMed.

Vertebroplasty patients should be prescribed medications to stave off osteoporosis, Dr. Kallmes says. "We know from many studies that these medications can cut fracture risk in half," he explains. "The vertebroplasty group is at particularly high risk of fractures, and we need to pay close attention to their risk of osteoporosis."

Reference

  1. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Am J Neuroradiol. 2006;27:217-223.