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European Spine Journal

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01-09-2021 | Refracture | Review Article

Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis

Authors: Zhi Chen, Chenyang Song, Hailin Lin, Jun Sun, Wenge Liu

Published in: European Spine Journal | Issue 9/2021

Abstract

Purpose

In order to prevent the recurrent fracture after vertebral augmentation, the concept of prophylactic vertebral augmentation has been proposed, but its efficacy is still controversial. This study aimed to determine the efficacy of prophylactic vertebral augmentation for prevention of refracture in osteoporotic vertebral fracture patients.

Methods

Following PRISMA guidelines, a literature search was performed using PubMed, Embase and Web of Science databases for relevant studies published until February 2021. A meta-analysis of randomized controlled trials and retrospective controlled trials comparing prophylactic group versus nonprophylactic group was conducted. The primary outcome was the incidence of new vertebral compression fracture (VCF), and secondary outcomes were incidence of adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF).

Results

A total of 6 studies encompassing 618 patients were included in the meta-analysis. The incidence of new VCF was reported in all six studies, and the result showed no significant difference between the two groups (OR: 0.509; 95% CI: 0.184–1.409). Four studies provided data on the incidence of AVF, and it was revealed that there was no significant difference between the two groups (OR: 0.689; 95% CI: 0.109–4.371). In view of the incidence of RVF, prophylactic group also did not differ significantly compared with nonprophylactic group (OR: 0.535; 95% CI: 0.167–1.709).

Conclusions

The current evidence suggested that prophylactic vertebral augmentation might not be appropriate to diminish the risk of new VCF. Therefore, there is a need to investigate the mechanism of refracture and explore other preventive regimens to reduce the risk.

Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ (2020) Current concepts in the management of osteoporotic vertebral fractures: a narrative review. Asian Spine J 14:898–909. https://doi.org/10.31616/asj.2020.0594CrossRefPubMedPubMedCentral

Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ (2015) Projection of osteoporosis-related fractures and costs in China: 2010–2050. Osteoporos Int J Estab Res Coop Eur Found Osteoporos Natl Osteopor Found USA 26:1929–1937. https://doi.org/10.1007/s00198-015-3093-2CrossRef

Zhang T, Wang Y, Zhang P, Xue F, Zhang D, Jiang B (2020) What are the risk factors for adjacent vertebral fracture after vertebral augmentation? a meta-analysis of published studies. Global Spine J. https://doi.org/10.1177/2192568220978223CrossRefPubMedPubMedCentral

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Min Res Offic J Am Soc Bone Min Res 22:465–475. https://doi.org/10.1359/jbmr.061113CrossRef

Feng L, Feng C, Chen J, Wu Y, Shen JM (2018) The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord 19:195. https://doi.org/10.1186/s12891-018-2123-6CrossRefPubMedPubMedCentral

Musbahi O, Ali AM, Hassany H, Mobasheri R (2018) Vertebral compression fractures. British J Hosp Med. https://doi.org/10.12968/hmed.2018.79.1.36CrossRef

Klazen CAH, Lohle PNM, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OEH, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WPTM (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092. https://doi.org/10.1016/s0140-6736(10)60954-3CrossRefPubMed

Spross C, Aghayev E, Kocher R, Röder C, Forster T, Kuelling FA (2014) Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 23:1332–1338. https://doi.org/10.1007/s00586-013-3052-6CrossRef

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. https://doi.org/10.1093/rheumatology/39.12.1410CrossRef

10.

Kim MH, Lee AS, Min SH, Yoon SH (2011) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J 5:180–187. https://doi.org/10.4184/asj.2011.5.3.180CrossRefPubMedPubMedCentral

11.

Yi X, Lu H, Tian F, Wang Y, Li C, Liu H, Liu X, Li H (2014) Recompression in new levels after percutaneous vertebroplasty and kyphoplasty compared with conservative treatment. Arch Orthop Trauma Surg 134:21–30. https://doi.org/10.1007/s00402-013-1886-3CrossRefPubMed

12.

Yu W, Xu W, Jiang X, Liang D, Jian W (2018) Risk factors for recollapse of the augmented vertebrae after percutaneous vertebral augmentation: a systematic review and meta-analysis. World Neurosurg 111:119–129. https://doi.org/10.1016/j.wneu.2017.12.019CrossRefPubMed

13.

Zhang H, Xu C, Zhang T, Gao Z, Zhang T (2017) Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? a meta-analysis. Pain Phys 20:E13-e28CrossRef

14.

Fan B, Wei Z, Zhou X, Lin W, Ren Y, Li A, Shi G, Hao Y, Liu S, Zhou H, Feng S (2016) Does vertebral augmentation lead to an increasing incidence of adjacent vertebral failure? a systematic review and meta-analysis. Int J Surg 36:369–376. https://doi.org/10.1016/j.ijsu.2016.11.082CrossRefPubMed

15.

Aquarius R, Homminga J, Hosman AJ, Verdonschot N, Tanck E (2014) Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: an in vitro cadaveric study. Med Eng Phys 36:944–948. https://doi.org/10.1016/j.medengphy.2014.03.009CrossRefPubMed

16.

Chiang CK, Wang YH, Yang CY, Yang BD, Wang JL (2009) Prophylactic vertebroplasty may reduce the risk of adjacent intact vertebra from fatigue injury: an ex vivo biomechanical study. Spine. https://doi.org/10.1097/BRS.0b013e31819481b1

17.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. https://doi.org/10.1136/bmj.b2535CrossRefPubMedPubMedCentral

18.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12. https://doi.org/10.1016/0197-2456(95)00134-4CrossRefPubMed

19.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-zCrossRefPubMed

20.

Jia P, Tang H, Chen H, Bao L, Feng F, Yang H, Li J (2017) Prophylactic vertebroplasty procedure applied with a resorbable bone cement can decrease the fracture risk of sandwich vertebrae: long-term evaluation of clinical outcomes. Regen Biomater 4:47–53. https://doi.org/10.1093/rb/rbw037CrossRefPubMed

21.

Kobayashi N, Numaguchi Y, Fuwa S, Uemura A, Matsusako M, Okajima Y, Ishiyama M, Takahashi O (2009) Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty. Acad Radiol 16:136–143. https://doi.org/10.1016/j.acra.2008.05.005CrossRefPubMed

22.

Yen CH, Teng MMH, Yuan WH, Sun YC, Chang CY (2012) Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty. Am J Neuroradiol 33:826–832. https://doi.org/10.3174/ajnr.A2898CrossRefPubMedPubMedCentral

23.

Eichler MC, Spross C, Ewers A, Mayer R, Külling FA (2016) Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience. J Neurosurg Spine 25:528–534. https://doi.org/10.3171/2016.2.Spine15907CrossRefPubMed

24.

Lei F, He W, Tian X, Li Z, Zheng L, Kang J, Feng D (2020) Prophylactic percutaneous kyphoplasty treatment for nonfractured vertebral bodies in thoracolumbar for osteoporotic patients. Biomed Res Int. https://doi.org/10.1155/2020/8593516CrossRefPubMedPubMedCentral

25.

Becker S, Garoscio M, Meissner J, Tuschel A, Ogon M (2007) Is there an indication for prophylactic balloon kyphoplasty? a pilot study. Clin Orthop Relat Res 458:83–89. https://doi.org/10.1097/BLO.0b013e318034032cCrossRefPubMed

26.

Rho YJ, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21:905–911. https://doi.org/10.1007/s00586-011-2099-5CrossRef

27.

Lee BG, Choi JH, Kim DY, Choi WR, Lee SG, Kang CN (2019) Risk factors for newly developed osteoporotic vertebral compression fractures following treatment for osteoporotic vertebral compression fractures. Spine J Off J North Am Spine Soc 19:301–305. https://doi.org/10.1016/j.spinee.2018.06.347CrossRef

28.

Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Intervent Radiol JVIR 17:71–76. https://doi.org/10.1097/01.Rvi.0000190910.43602.3cCrossRef

29.

Lim TH, Brebach GT, Renner SM, Kim WJ, Kim JG, Lee RE, Andersson GB, An HS (2002) Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty. Spine. https://doi.org/10.1097/00007632-200206150-00010CrossRefPubMed

30.

Chiang C-K, Wang Y-H, Yang C-Y, Yang B-D, Wang J-L (2009) Prophylactic vertebroplasty may reduce the risk of adjacent intact vertebra from fatigue injury an ex vivo biomechanical study. Spine 34:356–364. https://doi.org/10.1097/BRS.0b013e31819481b1CrossRefPubMed

31.

Furtado N, Oakland RJ, Wilcox RK, Hall RM (2007) A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine. https://doi.org/10.1097/BRS.0b013e31811ea2eeCrossRefPubMed

32.

Kamano H, Hiwatashi A, Kobayashi N, Fuwa S, Takahashi O, Saida Y, Honda H, Numaguchi Y (2011) New vertebral compression fractures after prophylactic vertebroplasty in osteoporotic patients. AJR Am J Roentgenol 197:451–456. https://doi.org/10.2214/ajr.10.5937CrossRefPubMed

33.

Wang L, Yang H, Shi Y, Luo Z, Jiang W, Bao Z, Chen K, Wang G (2012) Sandwich vertebral fracture in the study of adjacent-level fracture after vertebral cement augmentation. Orthopedics 35:e1225-1230. https://doi.org/10.3928/01477447-20120725-24CrossRefPubMed

34.

Kim YY, Rhyu KW (2010) Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19:1907–1912. https://doi.org/10.1007/s00586-010-1479-6CrossRef

35.

Tanigawa N, Kariya S, Komemushi A, Nakatani M, Yagi R, Kohzai M, Sawada S (2011) Percutaneous vertebroplasty for osteoporotic compression fractures: long-term evaluation of the technical and clinical outcomes. AJR Am J Roentgenol 196:1415–1418. https://doi.org/10.2214/ajr.10.5586CrossRefPubMed

36.

Villarraga ML, Bellezza AJ, Harrigan TP, Cripton PA, Kurtz SM, Edidin AA (2005) The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies. J Spinal Disord Tech 18:84–91. https://doi.org/10.1097/01.bsd.0000138694.56012.ceCrossRefPubMed

37.

Yoo CM, Park KB, Hwang SH, Kang DH, Jung JM, Park IS (2012) The analysis of patterns and risk factors of newly developed vertebral compression fractures after percutaneous vertebroplasty. J Korean Neurosurg Soc 52:339–345. https://doi.org/10.3340/jkns.2012.52.4.339CrossRefPubMedPubMedCentral

Title: Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis
Authors: Zhi Chen
Chenyang Song
Hailin Lin
Jun Sun
Wenge Liu
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keyword: Refracture
Published in: European Spine Journal / Issue 9/2021
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-021-06899-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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