Vertebral Augmentation May Improve Mortality in Patients with Osteoporotic Fractures
Radiology meta-analysis shows minimally invasive technique may extend life as well as relieve pain
For patients with osteoporotic vertebral compression fractures (OVCF), vertebral augmentation (VA) is an option that not only can improve quality of life — it may also help patients live longer, suggests research published in Radiology.
“We were surprised by the degree to which vertebral augmentation benefited mortality,” said Kenji Hinde, MD, a researcher at the Department of Radiology at Western Health and Western Hospital in Melbourne, Victoria, Australia.
Osteoporosis and low bone mass affect more than 50 million people in the U.S. Major morbidity and health care costs are related to OVCFs, which account for nearly half of all fractures. Data shows a 72% mortality rate at five years and 90% at seven years in patients with OVCFs.
In a meta-analysis of scientific literature involving more than two million patients, Dr. Hinde and colleagues analyzed mortality rates in patients with OVCFs who had undergone VA with vertebroplasty, or balloon kyphoplasty, versus those who had received nonsurgical management.
The researchers found that patients who underwent VA were 22% less likely to die at up to 10 years after treatment.
“It was exciting to see that our meta-analysis, which pooled data from different countries, patient populations and health care systems, still demonstrated significant mortality benefits for patients receiving vertebral augmentation compared with those that didn’t,” Dr. Hinde said. “This implies mortality benefits are not dependent on specific health systems but are associated with the procedures themselves and the impact they can have on pain, quality of life and patient function when compared with conservative therapy.”
Of the 16 studies included in the analysis, 10 involved patients in the U.S., while the remaining studies were from Australia, Austria, China, Germany, the United Kingdom and Taiwan.
While most of these studies examined only patients older than 65 years, several included patients of varying ages. Some studies included patients who underwent vertebroplasty or kyphoplasty alone, while others included patients who underwent both procedures, either analyzing each procedure separately or evaluating results of VA in general.
The study’s findings that kyphoplasty consistently outperformed vertebroplasty on mortality outcomes was also surprising, Dr. Hinde said.
“We hypothesize that this might relate to restoration of vertebral body height, leading to improved pulmonary function and/or mobility,” he said.
"It was exciting to see that our meta-analysis, which pooled data from different countries, patient populations and health care systems, still demonstrated significant mortality benefits for patients receiving vertebral augmentation compared with those that didn’t.”
KENJI HINDE, MD
Study Provides Important Data
The research was accompanied by a Radiology editorial by Jack W. Jennings, MD, PhD, an associate professor, chief of musculoskeletal radiology, and director of musculoskeletal and spine intervention at Washington University’s Mallinckrodt Institute of Radiology.
Dr. Jennings acknowledged the decades of controversy surrounding VA due to questions of safety and efficacy associated with the procedure. He noted that many trials exploring the efficacy of VA have examined it, “from a palliative, mechanical and quality of life perspective.”
“Despite the controversy on the palliative effects of vertebral augmentation, what has been relatively absent until recently was the impact of osteoporotic vertebral compression fractures on mortality outcomes and the survival benefit of vertebral augmentation,” Dr. Jennings wrote.
He emphasized that the study introduces data “that need to be at the forefront of the conversation regarding the efficacy of vertebral augmentation.”
“Pain is a very complex, intricate sensory phenomenon and often difficult to accurately quantify by the patient and the examiner when referenced as a single pain generator being studied. It is also challenging to separate it from other, non-studied sources of one’s overall pain burden,” Dr. Jennings wrote.
The new Radiology study suggests a more quantifiable benefit from VA. Researchers urge clinicians to consider it as a feasible option for patients who are appropriate candidates.
“Referral to informed and experienced specialists who can integrate the best available evidence with their clinical expertise and patient values will promote patient-centered decisions,” Dr. Hinde said. “We feel it is important that providers don’t automatically discard vertebral augmentation as a potential management option for osteoporotic vertebral compression fractures,” he added.
For More Information
Access the Radiology study, “Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.”
Access the Radiology editorial, “Vertebral Augmentation Is More than Just Pain Palliation, It Is about Improved Mortality.”