Bone Abstracts

We recently observed an increased risk for vertebral fractures (VF) in a randomized controlled trial comparing the analgesic effect of vertebroplasty (VP) vs conservative treatment (CT) in symptomatic VF. The aim of the present study was to evaluate the risk factors related to the development of VF after VP in these patients.

Methods and results: We evaluated risk factors including age, gender, bone mineral density, the number, type and severity of vertebral deformities at baseline, the number of vertebral bodies treated, the presence and location of disk cement leakage, bone remodeling (determining bone turnover markers) and 25 hydroxyvitamin D (25OHD) levels at baseline in all the patients (57 with VP and 61 with CT).Twenty-nine radiologically new VF were observed in 17/57 patients undergoing VP (72% adjacent to the VP) and 11 new VF in those receiving CT (27% adyacent to previous VF). Patients developing VF after VP showed an increased prevalence of 25OHD deficiency (<20 ng/ml) and higher PINP values than patients without new VF. 25OHD levels <20 ng/ml were the principal factor related to the development of VF after VP on multivariate analysis (RR 15.47; 95% CI 2.99–79.86, P<0.0001), whereas age >80 years (RR 3.20; 95% CI, 1.70–6.03, P=0.0007) and glucocorticoid therapy (RR, 3.64; 95% CI, 1.61–8.26, P=0.0055) constituted the principal factors in the overall study population. Increased risk of VF after VP was also associated with cement leakage into the inferior disk (RR 6.14; 95% CI, 1.65–22.78, P=0.044) and >1 vertebral body treated during VP (RR 4.19; 95% CI, 1.03–34.3, P=0.044).

Conclusion: Nearly 30% of patients with osteoporotic VF treated with VP had a new VF after the procedure. Age, especially over 80 years, the presence of inferior disk cement leakage after VP, the number of cemented vertebrae and low 25OHD serum levels were related to the development of new VF; the latter indicating the need to correct vitamin D deficiency prior to performing VP.