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Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study

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Abstract

Summary

To better understand the risk of secondary vertebral compression fracture (VCF) following a vertebroplasty or kyphoplasty, we compared patients treated with those procedures to patients with a previous VCF. The risk of subsequent fracture was significantly greater among treatment patients, especially within 90 days of the procedure.

Introduction

Predominantly uncontrolled studies suggest a greater risk of subsequent vertebral compression fractures (VCFs) associated with vertebroplasty/kyphoplasty. To further understand this risk, we conducted a population-based retrospective cohort study using data from a large regional health insurer.

Methods

Administrative claims procedure codes were used to identify patients receiving either a vertebroplasty or kyphoplasty (treatment group) and a comparison group of patients with a primary diagnosis of VCF who did not receive treatment during the same time period. The main outcomes of interest, validated by two independent medical record reviewers, were any new VCFs within (1) 90 days, (2) 360 days, and (3) at adjacent vertebral levels. Multivariable logistic regression examined the association of vertebroplasty/kyphoplasty with new VCFs.

Results

Among 48 treatment (51% vertebroplasty, 49% kyphoplasty) and 164 comparison patients, treated patients had a significantly greater risk of secondary VCFs than comparison patients for fractures within 90 days of the procedure or comparison group time point [adjusted odds ratio (OR) = 6.8; 95% confidence interval (CI) 1.7–26.9] and within 360 days (adjusted OR = 2.9; 95% CI 1.1–7.9).

Conclusions

Patients who had undergone vertebroplasty/kyphoplasty had a greater risk of new VCFs compared to patients with prior VCFs who did not undergo either procedure.

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References

  1. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515

    Article  PubMed  CAS  Google Scholar 

  2. Kallmes DF (2006) Randomized vertebroplasty trials: current status and challenges. Acad Radiol 13:546–549

    Article  PubMed  Google Scholar 

  3. Melton LJ 3rd, Kallmes DF (2006) Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol 13:538–545

    Article  PubMed  Google Scholar 

  4. Truumees E, Hilibrand A, Vaccaro AR (2004) Percutaneous vertebral augmentation. Spine J 4:218–229

    Article  PubMed  Google Scholar 

  5. Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty: a biomechanical investigation. J Bone Joint Surg Br 84:748–752

    Article  PubMed  CAS  Google Scholar 

  6. Polikeit A, Nolte L, Ferguson S (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 28:991–996

    Article  PubMed  Google Scholar 

  7. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  PubMed  CAS  Google Scholar 

  8. Brown DB, Gilula LA, Sehgal M, Shimony JS (2004) Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR 182:319–322

    PubMed  Google Scholar 

  9. Kasperk C, Hillmeier J, Noldge G, Grafe IA, DaFonseca K, Raupp D, Bardenheuer H, Libicher M, Liegibel UM, Sommer U, Hilscher U, Pyerin W, Vetter M, Meinzer H-P, Meeder P-J, Taylor RS, Nawroth P (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res 20:604–612

    Article  PubMed  Google Scholar 

  10. Baroud G, Nemes J, Heini P, Steffen T (2003) Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J 12:421–426

    Article  PubMed  CAS  Google Scholar 

  11. Trout AT, Kallmes DF (2006) Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol 27:1397–1403

    PubMed  CAS  Google Scholar 

  12. Diamond T, Bryant C, Browne L, Clark W (2006) Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 184:113–117

    PubMed  Google Scholar 

  13. Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265

    Article  PubMed  Google Scholar 

  14. Grafe IA, Da Fonseca K, Hillmeier J, Meeder PJ, Libicher M, Noldge G, Bardenheuer H, Pyerin W, Basler L, Weiss C, Taylor RS, Nawroth P, Kasperk C (2005) Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis. Osteoporos Int 16:2005–2012

    Article  PubMed  Google Scholar 

  15. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414

    Article  CAS  Google Scholar 

  16. Kobayashi K, Shimoyama K, Nakamura K, Murata K (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15:360–367

    Article  PubMed  Google Scholar 

  17. Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. CardioVasc Interv Radiol 29:580–585

    Article  Google Scholar 

  18. Voormolen MHJ, Lohle PNM, Juttmann JR, Graaf Y, Fransen H, Lampmann LEH (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17:71–76

    Article  PubMed  Google Scholar 

  19. Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, Kallmes DF (2007) Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 28:683–689

    PubMed  CAS  Google Scholar 

  20. Lee W, Sung K, Jeong H, Sung Y, Hyun Y, Choi J, Lee K, Ok C, Choi Y (2006) Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients. Eur Spine J 15:1777–1783

    Article  PubMed  Google Scholar 

  21. Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A (2005) New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR Am J Neuroradiol 26:1601–1604

    PubMed  Google Scholar 

  22. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124

    Article  PubMed  Google Scholar 

  23. Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29:2270–2276 discussion 2277

    Article  PubMed  Google Scholar 

  24. Harrop JS, Prpa B, Reinhardt MK, Lieberman I (2004) Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty. Spine 29:2120–2125

    Article  PubMed  Google Scholar 

  25. Tanigawa N, Komemushi A, Kariya S, Kojima H, Shomura Y, Sawada S (2006) Radiological follow-up of new compression fractures following percutaneous vertebroplasty. CardioVasc Interv Radiol 29:92–96

    Article  Google Scholar 

  26. Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 27:217–223

    PubMed  CAS  Google Scholar 

  27. Reginster JY, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteo Int 11:83–91

    Article  CAS  Google Scholar 

  28. Boonen S, McClung MR, Eastell R, El-Hajj Fuleihan G, Barton IP, Delmas P (2004) Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 52:1832–1839

    Article  PubMed  Google Scholar 

  29. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR, for the Multiple Outcomes of Raloxifene Evaluation I (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645

    Article  PubMed  CAS  Google Scholar 

  30. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M (2005) Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J 14:466–473

    Article  PubMed  CAS  Google Scholar 

  31. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg 85:83–89

    Article  CAS  Google Scholar 

  32. Lin EP, Ekholm S, Hiwatashi A, Westesson P-L (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25:175–180

    PubMed  Google Scholar 

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Acknowledgements

The authors thank Katherine Jackson Donnithorn and Raj Nair, MD for their assistance in medical record review. This study was supported by grants no. HS10389-07 from the Agency for Healthcare Research and Quality (AHRQ); no. AR52361-92 from the National Institute of Arthritis and Musculoskeletal and Skin Disease; and Social & Scientific Systems, Inc. contract no. 223-02-6003 with the Center for Devices and Radiological Health of the Food and Drug Administration (FDA).

Conflicts of interest

Ms. Mudano and Dr. Briggs are currently employed with Blue Cross Blue Shield of Alabama. Dr. Curtis receives research support from Merck, Novartis, Amgen, and Lilly, is a consultant for Roche, and has honoraria from Merck, Proctor & Gamble, Lilly and Roche. Dr. Saag receives consulting fees and research support from Merck, Novartis, Roche, Proctor & Gamble, Amgen, and Lilly and is a consultant for Glaxo Smith Kline. All other authors stated that they had no conflicts of interest.

Disclaimer

The opinions or assertions presented herein are the private views of the authors and are not to be construed as conveying either an official endorsement or criticism by the US Department of Health and Human Services, the Public Health Service, or the US Food and Drug Administration

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Authors and Affiliations

  1. Center for Education & Research on Therapeutics (CERTs) of Musculoskeletal Disorders, University of Alabama at Birmingham, 510 - 20th Street South, 820 FOT, Birmingham, AL, 35294-3408, USA

    A. S. Mudano, J. Bian, J. R. Curtis, J. J. Allison, Y. Kim, M. E. Melton, J. Xi & K. G. Saag

  2. Health Management, Blue Cross and Blue Shield of Alabama, Birmingham, AL, USA

    A. S. Mudano & D. Briggs

  3. Atlanta Veteran Affairs Medical Center, Atlanta, GA, USA

    J. Bian

  4. Center for Devices and Radiological Health, Food and Drug Administration, Office of Surveillance and Biometrics, Rockville, MD, USA

    J. U. Cope & T. P. Gross

Authors
  1. A. S. Mudano
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  2. J. Bian
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  3. J. U. Cope
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  4. J. R. Curtis
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  6. J. J. Allison
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  7. Y. Kim
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  8. D. Briggs
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  9. M. E. Melton
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  10. J. Xi
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  11. K. G. Saag
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Corresponding author

Correspondence to K. G. Saag.

Appendix

Appendix

Table 3 Diagnostic and procedure codes used for identification and exclusions of vertebroplasty/kyphoplasty treatment and comparison groups
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Mudano, A.S., Bian, J., Cope, J.U. et al. Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20, 819–826 (2009). https://doi.org/10.1007/s00198-008-0745-5

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  • DOI: https://doi.org/10.1007/s00198-008-0745-5

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