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There is no association between this fracture and future osteoporotic fragility fractures.
2%
126/5931
Prospective, randomized, double blinded studies have recently showed improvement with vertebroplasty.
15%
884/5931
2-year mortality rates are roughly equivalent to those associated with hip fractures.
57%
3353/5931
This fracture results in chronic back pain in the majority of patients regardless of treatment.
25%
1466/5931
Neurologic deterioration is a common complication with this injury pattern.
1%
55/5931
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The clinical presentation and radiographs are consistent with an acute osteoporotic vertebral compression fracture. The mortality rate of patients with vertebral osteoporotic compression fractures is similar to patients with hip fractures when followed beyond 6 months. Osteoporotic compression fractures are the most common fragility fracture. Due to the high prevalence of this injury, there is a large socioeconomic burden associated with the disease and there has been significant controversy regarding optimal treatment. Several recent prospective, randomized, double-blinded studies failed to show any significant improvement with vertebroplasty. Studies looking at the treatment effects of kyphoplasty, as opposed to vertebroplasty, remain controversial. Buchbinder et al. performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months duration and unhealed were randomly assigned to undergo vertebroplasty or a sham procedure. They found improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in the control group. Kallmes et al. performed a multicenter trial that randomly assigned 131 patients who had one to three painful osteoporotic vertebral compression fractures to undergo either vertebroplasty or a simulated procedure without cement. They found improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in the control group. In the recently published treatment guidelines for osteoporotic spinal compression fractures, the AAOS recommends strongly against the use of vertebroplasty. They report kyphoplasty is an option for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms, although they note the strength of their recommendation is "limited". Figure A and B show the radiographs of an osteoporotic compression fracture at T12. Diffuse osteopenia is apparent. Incorrect Answers: Answer 1: After the initial fracture patients have a 20% risk of further fractures. Answer 2: Recent prospective, randomized, double-blinded studies have failed to show improvement with vertebroplasty compared to nonoperative treatment. Answer 4: With nonoperative treatment, patients have good outcomes and there is not a high association with chronic back pain. Answer 5: Osteoporotic vertebral compression fractures are associated with neurologic complications in less than 1% of patients.
2.8
(44)
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