AMSTERDAM, The Netherlands – Patients with painful vertebral fractures gain major benefits from a minimally invasive surgical technique that reduces pain, improves mobility, and appears to cut the risk of further fractures, according to a presentation at the 2006 EULAR meeting by Christian Kasperk, MD, of Heidelberg University, Heidelberg, Germany.¹ Kyphoplasty, which involves the insertion of cement around a fracture, could be the answer to "a crying insufficiency of osteoporotic pharmacologic treatments," Dr. Kasperk said.

According to Dr. Kasperk, while new pharmacologic treatments are able to prevent up to 50% of osteoporotic fractures, many patients are still suffering pain as a result of vertebral fractures that persist for several months.

"One fracture predisposes the patient to another fracture and, more importantly, to pain, disability, and eventually immobility—with the latter creating the risk of further bone loss in osteoporotic patients," he said.

The realization that the pain of vertebral fractures is caused by irritation from the moving vertebral plates led to the development of vertebroplasty, with the more recent refinement of kyphoplasty, in which the vertebral plates are first separated and held in place temporarily by a balloon before being cemented into position. Dr. Kasperk said that research carried out at Heidelberg has shown that the minimally invasive technique reduces pain levels and improves mobility for at least 3 years—bringing instant relief to patients who would otherwise take up to a year to recover with conservative treatment.

Dr. Kasperk acknowledged the concern that firming up one vertebra might predispose patients to further fracturing, and indeed a study presented earlier this month at the World Congress on Osteoporosis in Toronto reported a doubling of fractures in a retrospective analysis of osteoporosis patients treated with vertebroplasty compared with those treated with an osteoporosis exercise program.²

However, he also made it clear that his observations suggest the opposite. "There appear to be far fewer fractures among those who are treated with kyphoplasty, and we believe that a combination of better mobility and neuromuscular activity prevent the falls that lead to fractures," he said.

Only a randomized controlled trial can determine whether cementing vertebrae increases the risk of fractures, and Dr. Kasperk told meeting participants that his group is now undertaking such a study.

Reference

1. Kypho-vertebroplasty and nonpharmacologic treatment. Presented at: EULAR 2006; June 21–24, 2006; Amsterdam, the Netherlands. Abstract SP0033.
2. Schmidt CK, Huntoon EA, Sinaki M. Efficacy of exercise and vertebroplasty in reducing risk of recurrent vertebral fractures in the osteoporotic patient. Presented at: International Osteoporosis Foundation World Congress on Osteoporosis; June 2–6, 2006; Toronto, Canada. Abstract P434SU.