Background Adjacent fracture of the cemented vertebrae may result from unfilled space left during the procedure or from crushed fragile trabeculae underneath the cement during follow-up, suggesting impaired bone marrow integrity of the injured vertebrae. Anti-osteoporotic therapy is reported to increase spinal, total hip, and femoral neck bone mineral density1. If treating osteoporosis does have a positive impact on adjacent fracture among patients who have undergone vertebroplasty, there will be several important potential implications for managing skeletal health specifically and for the health care of the elderly in general.
Objectives This study aimed to determine if anti-osteoporotic therapy can decrease the risk of adjacent fracture in patients with acute vertebral fracture after vertebroplasty.
Methods This retrospective study reviewed of cases of osteoporosis patients with magnetic resonance imaging (MRI)-proven acute vertebral fractures between 2001 and 2007. Osteoporotic patients were investigated as determined by pre-operative MRI with subsequent adjacent fracture of the cemented vertebrae and for the possibility of anti-osteoporotic therapy decreasing the progression of collapse after a minimum of 6 months follow-up. All associated co-morbidities were recorded, as well as the use of anti-osteoporotic drugs (i.e., alendronate, raloxifen, calcitonin, and teriparatide). Cox regression analysis was also performed.
Results The 192 patients with acute vertebral fractures who underwent vertebroplasty and anti-osteoporotic therapy had a mean age of 74.40±6.41. The basic characteristics of patients with and without adjacent fracture differed in age, body mass index, rheumatoid arthritis, and use of glucocorticoids and anti-osteoporotic drugs (Table 1). Using the Kaplan-Meier curve, anti-osteoporotic therapy after vertebroplasty had a significant effect on adjacent fracture (p=0.037, by log rank text). After adjusting for potential confounders, patients with anti-osteoporotic therapy still had a lower adjacent fracture rate than patients without anti-osteoporotic therapy (p=0.006; HR: 2.137, 95% CI: 1.1238–3.690). The adjacent fracture rate also increased in old age (p=0.019; HR: 1.049; 95% CI:1.008–1.039) and among smokers (p=0.026; HR: 3.891; 95% CI: 1.175–12.890).
Conclusions In this study, adjacent fracture of cemented vertebrae is inevitable after vertebroplasty but can be mitigated by anti-osteoporotic therapy to increase bone mass.
Center JR, et al. J Clin Endocrinol Metab. 2011;96(4):1006–14.
Disclosure of Interest None declared