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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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.
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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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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