AAOS balks at vertebroplasty procedures

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The American Academy of Orthopedic Surgeons (AAOS) said it was unable to recommend the majority of common clinical interventions for treating osteoporotic spinal compression fractures, with a particular caution against vertebroplasty procedures.

In fact, the only “strong” recommendation from AAOS was against treating compression fractures using vertebroplasty procedures, in which cement is injected into the spine to reduce pain. “By making a strong recommendation against the use of vertebroplasty, the group is expressing its confidence that future evidence is unlikely to overturn the results of these trials,” the report’s author, Robert A. McGuire, Jr., MD, of University of Mississippi School of Medicine, said.

After a systematic review of current scientific and clinical evidence, panel meetings and committee hearings, AAOS called six out of 11 of the accepted clinical treatments for osteoporotic compression fractures “inconclusive.” The academy decided it could “weakly” recommend three other treatments and only “moderately” recommend two interventions.

The AAOS guideline for osteoporotic compression fractures, which affect 750,000 patients each year in the U.S., said high-quality evidence did not exist, and the academy therefore could not recommend such common treatments as opiods/analgesics, bedrest, electrical stimulation, exercise or bracing.

The group did weakly recommend kyphloplasty, a procedure similar to vertebroplasty, saying that the evidence showed that the procedure showed “possibly clinically important” results for up to 12 months. AAOS also weakly recommended nerve blocks and treatment with ibandronate and strontium relenate, and moderately recommending a four week dose of calcitonin.

While the organization's recommendations did not bode well for physicians and patients of osteoporotic spinal compression fractures, AAOS said it will affect one out of four people over 50 years of age at some point in their lives: “We hope this will be an incentive for researchers to develop and conduct quality studies in these areas.”

To view a list of AAOS's recommendations, click here.