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Iwamae M, Takahashi S, Terai H, Tamai K, Hoshino M, Kobayashi Y, Umano M, Sasaki R, Uematsu M, Katsuda H, Shimada N, Nakamura H. Is Orthotic Treatment Beneficial for Fresh Osteoporotic Vertebral Fractures? A Propensity Score Matching Study. Spine J 2024:S1529-9430(24)00927-6. [PMID: 39147142 DOI: 10.1016/j.spinee.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/13/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND CONTEXT Orthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit. PURPOSE To investigate the effectiveness of orthotic treatment for OVF. STUDY DESIGN/SETTING Retrospective cohort study with data from two prospective studies. PATIENT SAMPLE This study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies. OUTCOME MEASURES The visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time. METHODS The patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group. RESULTS Each group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p = 0.87, p = 0.39 and p = 0.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p = 0.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p = 0.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p = 0.028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20-1.09, p = 0.054). CONCLUSIONS Although orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF. CLASSIFICATIONS Clinical study.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | | | - Yuto Kobayashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | | | - Ryo Sasaki
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital
| | - Masato Uematsu
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | | | | | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller HH, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences. Disabil Rehabil 2024; 46:2999-3006. [PMID: 37493172 DOI: 10.1080/09638288.2023.2239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/15/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada; Toronto, Canada
| | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, North York, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
| | - Judi Laprade
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Suzanne N Morin
- McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | | | - Zach Weston
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, Canada
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Macciacchera M, McDonnell JM, Amir A, Sowa A, Cunniffe G, Darwish S, Murphy C, Butler JS. Mechanical Vertebral Body Augmentation Versus Conventional Balloon Kyphoplasty for Osteoporotic Thoracolumbar Compression Fractures: A Systematic Review and Meta-Analysis of Outcomes. Global Spine J 2024:21925682241261988. [PMID: 38889443 DOI: 10.1177/21925682241261988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. However, the effectiveness of MPVA systems vs conventional augmentation techniques for OVCFs remains unclear. This serves as the premise for this study. METHODS A systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies of interest included randomized controlled trials (RCTs) which directly compared patient outcomes following kyphoplasty to patients treated with MPVA systems. Clinical and radiological findings were collated and compared for significance between cohorts. RESULTS 6 RCTs were identified with 1024 patients total. The mean age of all patients was 73.5 years. 17% of the cohort were male, 83% were female. 515 patients underwent kyphoplasty and 509 underwent mechanical vertebral body augmentation using MPVA systems. MPVAs showed similar efficacy for restoration of vertebral body height (P = .18), total complications (P = .36), cement extravasation (P = .58) and device-related complications (P = .06). MPVAs also showed reduced rates of all new fractures (16.4% vs 22.2%; P = .17) and adjacent fractures (14.7% vs 18.9%; P = .23), with improved visual analogue scale (VAS) scores at 6-month (P = .13). CONCLUSION The results of this meta-analysis highlight no significant improvement in clinical or radiological outcomes for MPVA systems when compared to balloon kyphoplasty for vertebral body augmentation. Further research is needed to establish a true benefit over traditional operative methods.
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Affiliation(s)
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Aisyah Amir
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aubrie Sowa
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University of College Dublin, Belfield, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciara Murphy
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Advanced Materials and BioEngineering Research= (AMBER) Centre, Trinity College Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University of College Dublin, Belfield, Dublin, Ireland
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Ueno M, Tajima Y, Ito S, Tsuji M, Toriumi E, Yoshii A, Otake N, Tanaka H. Comparative analysis of anti-osteoporosis medications in preventing vertebral body fractures after balloon kyphoplasty. Arch Osteoporos 2024; 19:19. [PMID: 38512565 DOI: 10.1007/s11657-024-01374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
This retrospective study compared the efficacy of anabolic agents (romosozumab and teriparatide) with that of alendronate in preventing subsequent vertebral body fractures (SVBFs) after balloon kyphoplasty (BKP). All anabolic agents significantly reduced SVBFs. Romosozumab was most effective in increasing bone mineral density (BMD) and completely suppressed distant vertebral body fractures. INTRODUCTION To determine optimal anti-osteoporosis medications, we compared romosozumab and teriparatide to alendronate as a control from perioperative BKP to the 1st postoperative year for treatment and secondary fracture prevention in osteoporosis. METHODS A total of 603 patients who underwent initial BKP for osteoporotic vertebral fractures were evaluated and categorized into five groups based on drug administration: romosozumab (group R, 155 patients), twice-weekly teriparatide (group TW, 48), weekly teriparatide (group W, 151), daily teriparatide (group D, 138), and alendronate (control) (group C, 111). The 1-year incidence of SVBFs, BMD change rate, and probability of requiring BKP were compared among the groups. RESULTS SVBF incidence was 3.9%, 6.5%, 8.3%, 6.0%, and 14.4% in groups R, D, TW, W, and C, respectively, with all other groups exhibiting significantly lower rates than group C. The groups that administered the anabolic agents had a notably lower incidence of distant fractures than group C. Compared with group C, group R showed significantly higher BMD change rates in lumbar vertebral bodies at 4, 8, and 12 months and group D at 12 months. Anabolic agent groups exhibited significantly higher improvement rates than group C after conservative treatment alone. CONCLUSION The anabolic agents were found to be more effective at reducing the incidence of SVBF (especially distant vertebral fractures) than alendronate. These agents decreased the rate of repeat BKP even after the occurrence of a fracture. Overall, the use of an anabolic agent for the treatment of osteoporosis after BKP is better than the use of alendronate, even when treatment is initiated in the perioperative stage.
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Affiliation(s)
- Masaki Ueno
- Department of Orthopaedic Surgery, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan.
| | - Yusuke Tajima
- Department of Orthopaedic Surgery, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Shogo Ito
- Department of Orthopaedic Surgery, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Masaki Tsuji
- Department of Orthopaedic Surgery, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Emi Toriumi
- Department of Rehabilitation, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Aki Yoshii
- Department of Rehabilitation, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Nanaka Otake
- Department of Rehabilitation, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
| | - Hisashi Tanaka
- Department of Radiology, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan
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Abd-Elsayed A, Chitneni A. Perioperative care for vertebral augmentation. VERTEBRAL AUGMENTATION TECHNIQUES 2024:29-30. [DOI: 10.1016/b978-0-323-88226-2.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Jiang Y, Zhang W, Huang S, Huang Q, Ye H, Zeng Y, Hua X, Cai J, Liu Z, Liu Q. Preoperative Prediction of New Vertebral Fractures after Vertebral Augmentation with a Radiomics Nomogram. Diagnostics (Basel) 2023; 13:3459. [PMID: 37998595 PMCID: PMC10670105 DOI: 10.3390/diagnostics13223459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
The occurrence of new vertebral fractures (NVFs) after vertebral augmentation (VA) procedures is common in patients with osteoporotic vertebral compression fractures (OVCFs), leading to painful experiences and financial burdens. We aim to develop a radiomics nomogram for the preoperative prediction of NVFs after VA. Data from center 1 (training set: n = 153; internal validation set: n = 66) and center 2 (external validation set: n = 44) were retrospectively collected. Radiomics features were extracted from MRI images and radiomics scores (radscores) were constructed for each level-specific vertebra based on least absolute shrinkage and selection operator (LASSO). The radiomics nomogram, integrating radiomics signature with presence of intravertebral cleft and number of previous vertebral fractures, was developed by multivariable logistic regression analysis. The predictive performance of the vertebrae was level-specific based on radscores and was generally superior to clinical variables. RadscoreL2 had the optimal discrimination (AUC ≥ 0.751). The nomogram provided good predictive performance (AUC ≥ 0.834), favorable calibration, and large clinical net benefits in each set. It was used successfully to categorize patients into high- or low-risk subgroups. As a noninvasive preoperative prediction tool, the MRI-based radiomics nomogram holds great promise for individualized prediction of NVFs following VA.
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Affiliation(s)
- Yang Jiang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Wei Zhang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Shihao Huang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China;
| | - Qing Huang
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China;
| | - Haoyi Ye
- Department of Radiology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511300, China;
| | - Yurong Zeng
- Department of Radiology, Huizhou Central People’s Hospital, Huizhou 516000, China;
| | - Xin Hua
- Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China;
| | - Jinhui Cai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Zhifeng Liu
- Department of Radiology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511300, China;
| | - Qingyu Liu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
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Skjødt MK, Abrahamsen B. New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 2023; 108:e1175-e1185. [PMID: 37186550 DOI: 10.1210/clinem/dgad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. EVIDENCE ACQUISITION We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. EVIDENCE SYNTHESIS Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. CONCLUSIONS Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford OX3 7LD, UK
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Anastasilakis AD, Makras P, Paccou J, Bisbinas I, Polyzos SA, Papapoulos SE. Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab. J Clin Med 2023; 12:5874. [PMID: 37762815 PMCID: PMC10532339 DOI: 10.3390/jcm12185874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise.
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Affiliation(s)
| | - Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
| | - Julien Paccou
- Department of Rheumatology, University of Lille, 59000 Lille, France;
| | - Ilias Bisbinas
- First Department of Orthopaedics, 424 Military General Hospital, 564 29 Thessaloniki, Greece;
| | - Stergios A. Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Socrates E. Papapoulos
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, 115 25 Athens, Greece;
- Center for Bone Quality, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Gold LS, Suri P, O'Reilly MK, Kallmes DF, Heagerty PJ, Jarvik JG. Mortality among older adults with osteoporotic vertebral fracture. Osteoporos Int 2023; 34:1561-1575. [PMID: 37233794 PMCID: PMC10718299 DOI: 10.1007/s00198-023-06796-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving kyphoplasty were at reduced risk of death but after matching on age and medical complications, patients who received kyphoplasty were at increased risk of death. PURPOSE In previous observational studies, kyphoplasty for treatment of osteoporotic vertebral fractures has been associated with decreased mortality compared to conservative management. The purpose of this research was to determine whether older adults who received kyphoplasty had reduced risk of mortality compared to matched patients who did not. METHODS Retrospective cohort study of US Medicare enrollees with osteoporotic vertebral fractures between 2017-2019 comparing patients who underwent kyphoplasty to those who did not. We identified 2 control groups a priori: 1) non-augmented patients who met inclusion criteria (group 1); 2) propensity-matched patients on demographic and clinical variables (group 2). We then identified additional control groups using matching for medical complications (group 3) and age + comorbidities (group 4). We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with mortality. RESULTS A total of 235,317 patients (mean (± standard deviation) age 81.1 ± 8.3 years; 85.8% female) were analyzed. In the primary analyses, those who received kyphoplasty were at reduced risk of death compared to those who did not: adjusted HR (95% CI) in group 1 = 0.84 (0.82, 0.87); and in group 2 = 0.88 (0.85, 0.91). However, in post hoc analyses, patients who received kyphoplasty were at increased risk of death: adjusted HR (95% CI) in group 3 = 1.32 (1.25, 1.41) and 1.81 (1.58, 2.09) in group 4. CONCLUSION An apparent benefit of kyphoplasty on mortality among patients with vertebral fractures was not present after rigorous propensity matching, illustrating the importance of comparing similar individuals when evaluating observational data.
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Affiliation(s)
- Laura S Gold
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA.
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
| | - Pradeep Suri
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
- Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Michael K O'Reilly
- Department of Radiology, University of Limerick Hospital Group, Limerick, Ireland
| | | | - Patrick J Heagerty
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jeffrey G Jarvik
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
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Federico VP, Zavras AG, Butler A, Nolte MT, Munim MA, Lopez GD, DeWald C, An HS, Colman MW, Phillips FM. Medicare Reimbursement Rates and Utilization Trends in Sacroiliac Joint Fusion. J Am Acad Orthop Surg 2023; 31:923-930. [PMID: 37192412 DOI: 10.5435/jaaos-d-22-00800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Sacroiliac joint (SIJ) fusion is a surgical treatment option for SIJ pathology in select patients who have failed conservative management. More recently, minimally invasive surgical (MIS) techniques have been developed. This study aimed to determine the trends in procedure volume and reimbursement rates for SIJ fusion. METHODS Publicly available Medicare databases were assessed using the National Summary Data Files for 2010 to 2020. Files were organized according to current procedural terminology (CPT) codes. CPT codes specific to open and MIS SI joint fusion (27279 and 27280) were identified and tracked. To track surgeon reimbursements, the CMS Medicare Physician Fee Schedule Look-Up Tool was used to extract facility prices. Descriptive statistics and linear regression were used to evaluate trends in procedure volume, utilization, and reimbursement rates. Compound annual growth rates were calculated, and discrepancies in inflation were corrected for using the Consumer Price Index. RESULTS A total of 33,963 SIJ fusions were conducted in the Medicare population between 2010 and 2020, with an overall increase in procedure volume of 2,350.9% from 318 cases in 2010 to 7,794 in 2020. Since the introduction of the 27279 CPT code in 2015, 8,806 cases (31.5%) have been open and 19,120 (68.5%) have been MIS. Surgeon reimbursement for open fusions increased nominally by 42.8% (inflation-adjusted increase of 20%) from $998 in 2010 to $1,425 in 2020. Meanwhile, reimbursement for MIS fusion experienced a nominal increase of 58.4% (inflation-adjusted increase of 44.9%) from $582 in 2015 to $922 in 2020. CONCLUSION SIJ fusion volume in the Medicare population has increased substantially in the past 10 years, with MIS SIJ fusion accounting for most of the procedures since the introduction of the 27279 CPT code in 2015. Reimbursement rates for surgeons have also increased for both open and MIS procedures, even after adjusting for inflation.
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Affiliation(s)
- Vincent P Federico
- From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Hayek SM, Jones BA, Veizi E, Tran TQ, DeLozier SJ. Efficacy of Continuous Intrathecal Infusion Trialing with a Mixture of Fentanyl and Bupivacaine in Chronic Low Back Pain Patients. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:796-808. [PMID: 36515491 PMCID: PMC10321766 DOI: 10.1093/pm/pnac195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Intrathecal trialing is used as a screening prognostic measure prior to intrathecal drug delivery system implant. The purpose of this study was to determine the efficacy of a continuous intrathecal infusion of an admixture of bupivacaine and fentanyl in patients with chronic low back pain. Patients with refractory chronic low back pain in the setting of previous lumbar spine surgery and/or chronic vertebral compression fracture(s) were enrolled in a randomized double blind cross-over study comparing saline infusion to infusion of a solution containing bupivacaine combined with low-dose fentanyl over a 14-18 hour period. The primary outcome measure was the change in pain intensity at the end of the screening trial. Patients who experienced significant pain reduction from either infusion relative to baseline pain were offered a permanent implant. In total, 36 patients were enrolled, with 31 patients trialed and 25 implanted. At the end of the screening trial, pain scores, at rest or with activity, decreased appreciably in both groups; however, significantly better improvements occurred in the fentanyl/bupivacaine group compared to saline both with activity and at rest (P = .016 and .006, respectively). Treatment order appeared to affect outcome with saline demonstrating a placebo response. At 12 months following implant, primary and secondary outcome measures continued to be significantly reduced from baseline. Continuous intrathecal delivery of a combination of zlow-dose fentanyl with bupivacaine is superior to saline in screening intrathecal trialing for back pain reduction. With longer term delivery, a sustained reduction of chronic low back pain was also observed.
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Affiliation(s)
- Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Anesthesiology/Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Bradford A Jones
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Anesthesiology/Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Pain Medicine Service, Northeast Ohio VA Health Care System (NEOHVAHCS), Cleveland, Ohio, USA
| | | | - Thang Q Tran
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah J DeLozier
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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12
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Carli D, Venmans A, Lodder P, Donga E, van Oudheusden T, Boukrab I, Schoemaker K, Smeets A, Schonenberg C, Hirsch J, de Vries J, Lohle P. Vertebroplasty versus Active Control Intervention for Chronic Osteoporotic Vertebral Compression Fractures: The VERTOS V Randomized Controlled Trial. Radiology 2023; 308:e222535. [PMID: 37462495 DOI: 10.1148/radiol.222535] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Evidence regarding percutaneous vertebroplasty (PV) for chronic painful osteoporotic vertebral compression fractures (OVCFs) remains limited. Purpose To compare pain relief, quality of life, and disability between PV and active control (anesthetic infiltration) interventions for chronic OVCF. Materials and Methods This prospective randomized clinical trial was conducted between May 2013 and June 2019 in participants with pain due to OVCF lasting longer than 3 months with bone marrow edema present at MRI. Study participants were randomly assigned to undergo PV (n = 40) or active control intervention (n = 40). The primary outcome was pain severity, assessed with the visual analog scale (VAS) (range, 0-10) during 12 months after treatment. Secondary outcomes included Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) score (range, 0-100) and Roland Morris Disability Questionnaire (RMDQ) score (range, 0-100). Outcomes were analyzed according to a longitudinal multilevel model used to test the difference between groups in change from baseline across follow-up. Results The mean age of the 80 participants (54 women) was 69 years ± 10 (SD) in the PV group and 71 years ± 10 in the active control group. VAS score was 7.6 (95% CI: 7.0, 8.2) in the PV group and 7.3 (95% CI: 6.9, 7.8) in the active control group at baseline (P = .47) and 3.9 (95% CI: 3.1, 4.8) and 5.1 (95% CI: 4.3, 6.0), respectively, at month 12 (P = .045). At month 12, the group difference from baseline was 1.3 (95% CI: 0.1, 2.6; P = .02) for VAS, 5.2 (95% CI: 0.9, 9.4; P = .02) for QUALEFFO, and 7.1 (95% CI: -3.3, 17.5; P = .18) for RMDQ, favoring the PV group. Conclusion In the treatment of pain caused by chronic OVCFs, PV is more effective for pain relief and quality of life improvement than anesthetic injection alone, with similar improvement for disability between the groups. Clinical trial registration no. NCT01963039 © RSNA, 2023 See also the editorial by Beall and De Leacy in this issue.
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Affiliation(s)
- Dennis Carli
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Alexander Venmans
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Paul Lodder
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Esther Donga
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Thijs van Oudheusden
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Issam Boukrab
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Kees Schoemaker
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Albert Smeets
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Catharina Schonenberg
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Joshua Hirsch
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Jolanda de Vries
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Paul Lohle
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
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13
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Tibert N, Ponzano M, Brien S, Funnell L, Gibbs JC, Jain R, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio L. Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences. Clin Rehabil 2023; 37:713-724. [PMID: 36510450 DOI: 10.1177/02692155221144370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures. DESIGN AND SETTING We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective. PARTICIPANTS Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71 ± 8 years). RESULTS Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies. CONCLUSION Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.
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Affiliation(s)
- Nicholas Tibert
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
| | | | - Suzanne N Morin
- 5620McGill University, Montréal, QC, Canada
- Research Institute of McGill University Health Centre, Montréal, QC, Canada
| | | | - Zach Weston
- 8431Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, 8430University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology and Health Sciences, Waterloo, ON, Canada
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14
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He X, Wang Y, Liu Z, Weng Y, Chen S, Pan Q, Li Y, Wang H, Lin S, Yu H. Osteoporosis treatment using stem cell-derived exosomes: a systematic review and meta-analysis of preclinical studies. Stem Cell Res Ther 2023; 14:72. [PMID: 37038180 PMCID: PMC10088147 DOI: 10.1186/s13287-023-03317-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/29/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The increasing incidence of osteoporosis in recent years has aroused widespread public concern; however, existing effective treatments are limited. Therefore, new osteoporosis treatment methods, including stem cell transplantation and exosome therapy, have been proposed and are gaining momentum. Exosomes are considered to have greater potential for clinical application owing to their immunocompatibility. This study summarises the latest evidence demonstrating the efficacy of exosomes in improving bone loss in the treatment of osteoporosis. MAIN TEXT This systematic review and meta-analyses searched PubMed, Embase, and Cochrane Library databases from inception to 26 March 2022 for osteoporosis treatment studies using stem cell-derived exosomes. Six endpoints were selected to determine efficacy: bone mineral density, trabecular bone volume/tissue volume fraction, trabecular number, trabecular separation, trabecular thickness, and cortical thickness. The search generated 366 citations. Eventually, 11 articles that included 15 controlled preclinical trials and 242 experimental animals (rats and mice) were included in the meta-analysis. CONCLUSION The results were relatively robust and reliable despite some publication biases, suggesting that exosome treatment increased bone mass, improved bone microarchitecture, and enhanced bone strength compared with placebo treatments. Moreover, stem cell-derived exosomes may favour anabolism over catabolism, shifting the dynamic balance towards bone regeneration.
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Affiliation(s)
- Xiaoyu He
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Yangbin Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Zhihua Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Yiyong Weng
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Shupeng Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Qunlong Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Yizhong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Hanshi Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
- Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia.
| | - Haiming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Quanzhou, 362000, Fujian Province, China.
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15
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Sato K, Kogawa M, Yamada Y, Yamashiro M, Kasama F, Matsuda M. Equivalent values between anterior vertebral height, wedge ratio, and wedge angle for evaluating vertebral mobility and deformity in osteoporotic vertebral fractures: a conventional observational study. J Orthop Surg Res 2023; 18:284. [PMID: 37031169 PMCID: PMC10082485 DOI: 10.1186/s13018-023-03758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/26/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Vertebral mobility (V-mobility) has been used to diagnose fresh osteoporotic vertebral fractures (OVFs) and determine bone union by setting cutoff values for these purposes. V-mobility is the difference in vertebral height on dynamic radiographs taken in the sitting and lateral decubitus or supine positions. The dimensions for V-mobility were presented as anterior vertebral height (Ha; mm), wedge ratio (WR; %), and wedge angle (WA; °) in previous reports. This study was performed to obtain WR and WA values equivalent to V-mobility of 1.0 mm in Ha. METHODS Lateral radiographs of 284 OVFs (grade 1-3 deformed vertebrae) from T11 to L2 were obtained from 77 patients with OVF. V-mobility presented as Ha, posterior vertebral height, and WA was obtained by the difference in these dimensions on dynamic radiographs. The WR and WA values equivalent to 1.0 mm in Ha were obtained by dividing the V-mobility values for WR and WA by that for Ha. RESULTS The mean WR values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 3.2% ± 1.4%, 3.2% ± 0.9%, and 3.4% ± 1.0%, respectively, and the corresponding value for grade 1-3 vertebrae was 3.3% ± 1.0%. The mean WA values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 1.5° ± 0.8°, 1.5° ± 0.6°, and 1.5° ± 0.8°, respectively, and the corresponding value for grade 1-3 vertebrae was 1.5° ± 0.7°. CONCLUSIONS The WR and WA values equivalent to V-mobility of 1.0 mm in Ha were 3.3% and 1.5°, respectively, in grade 1-3 vertebrae. These findings may be useful to secure a reliable value of V-mobility of OVFs using simultaneous measurements in three dimensions (Ha, WR, and WA) in clinical practice and to establish cutoff values for V-mobility to determine bone union.
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Affiliation(s)
- Kozo Sato
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Masakazu Kogawa
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan.
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, The University of Adelaide, North Terrace and George St., Adelaide, SA, 5005, Australia.
| | - Yuichiro Yamada
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Masahiro Yamashiro
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Fumio Kasama
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Michimasa Matsuda
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
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16
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Wang T, Liu K, Wang J, Xiang G, Hu X, Bai H, Lei W, Tao TH, Feng Y. Spatiotemporal Regulation of Injectable Heterogeneous Silk Gel Scaffolds for Accelerating Guided Vertebral Repair. Adv Healthc Mater 2023; 12:e2202210. [PMID: 36465008 DOI: 10.1002/adhm.202202210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/27/2022] [Indexed: 12/12/2022]
Abstract
Osteoporotic vertebral fracture is jeopardizing the health of the aged population around the world, while the hypoxia microenvironment and oxidative damage of bone defect make it difficult to perform effective tissue regeneration. The balance of oxidative stress and the coupling of vessel and bone ingrowth are critical for bone regeneration. In this study, an injectable heterogeneous silk gel scaffold which can spatiotemporally and sustainedly release bone mesenchymal stem cell-derived small extracellular vesicles, HIF-1α pathway activator, and inhibitor is developed for bone repair and vertebral reinforcement. The initial enhancement of HIF-1α upregulates the expression of VEGF to promote angiogenesis, and the balance of reactive oxygen species level is regulated to effectively eliminate oxidative damage and abnormal microenvironment. The subsequent inhibition of HIF-1α avoids the overexpression of VEGF and vascular overgrowth. Meanwhile, complex macroporous structures and suitable mechanical support can be obtained within the silk gel scaffolds, which will promote in situ bone regeneration. These findings provide a new clinical translation strategy for osteoporotic vertebral augmentation on basis of hypoxia microenvironment improvement.
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Affiliation(s)
- Tianji Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Keyin Liu
- State Key Laboratory of Transducer Technology, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai, 200050, China
| | - Jing Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Geng Xiang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Xiaofan Hu
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Hao Bai
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Tiger H Tao
- State Key Laboratory of Transducer Technology, Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences, Shanghai, 200050, China.,Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, China.,School of Physical Science and Technology, ShanghaiTech University, Shanghai, 200031, China.,Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, 200031, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, 200031, China
| | - Yafei Feng
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
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17
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Peckett KH, Ponzano M, Steinke A, Giangregorio LM. Bracing and taping interventions for individuals with vertebral fragility fractures: a systematic review of randomized controlled trials with GRADE assessment. Arch Osteoporos 2023; 18:36. [PMID: 36840787 DOI: 10.1007/s11657-023-01224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
This systematic review analyzes the effects of bracing and taping after osteoporotic vertebral fractures. Spinal orthose may have positive effects on pain, but the evidence is of very low certainty. Clinical judgment is recommended when prescribing spinal orthoses. PURPOSE To examine the effects of bracing and taping interventions on pain, physical functioning, health-related quality of life, back extensor strength, kyphosis curvature, and adverse events in individuals with vertebral fragility fractures. METHODS Four databases were searched from inception up to January 2022. We included randomized controlled trials testing the effect of bracing or taping interventions compared with a non-intervention control in adults ≥ 45 years with vertebral fragility fractures. Narrative syntheses were presented for all the outcomes. We assessed the risk of bias using the Cochrane Risk of Bias Assessment Tool and the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS Three studies were included. Soft bracing interventions exhibited inconsistent effects on pain. One study showed no difference between groups, and another study should a decrease in pain in the soft bracing group compared to the control group. Rigid bracing interventions did not have a significant change in pain between the control and intervention groups. One study demonstrated a decrease in pain at rest (VAS: - 10.8 ± 19.3) and during movement (VAS: - 20.9 ± 29.8) after a taping intervention. The other outcomes were not consistent across studies. CONCLUSIONS Spinal orthoses may improve pain in people with vertebral fractures; however, we cannot draw definitive conclusions on the efficacy or harms of bracing or taping due to the very low certainty evidence and the small number of studies. Effects on other outcomes are uncertain.
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Affiliation(s)
- Kimberly H Peckett
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Alex Steinke
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Canada.
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18
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston Z, Wideman TH, Giangregorio LM. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 2023; 34:1065-1074. [PMID: 36799981 DOI: 10.1007/s00198-023-06688-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
UNLABELLED We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. MAIN RESULTS This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures. SIGNIFICANCE These recommendations will guide clinical practice and inform interventions for future research. PURPOSE To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. METHODS We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median. RESULTS We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures. CONCLUSION Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada.
- International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.
| | - N Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
| | - S Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - L Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 - 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada
| | - J C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - J Laprade
- Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada
| | - S N Morin
- Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada
| | - Z Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada
- Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada
| | - T H Wideman
- School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada
| | - L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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19
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Eneling J, Darsaut TE, Raymond J. Trying to learn research methodology from the vertebroplasty saga. Neurochirurgie 2023; 69:101400. [PMID: 36608448 DOI: 10.1016/j.neuchi.2022.101400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 01/06/2023]
Affiliation(s)
- J Eneling
- Department of Radiology, service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - T E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - J Raymond
- Department of Radiology, service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
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20
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Trends in Hospitalization and Economic Impact of Percutaneous Kyphoplasty in Italy. J Clin Med 2022; 11:jcm11247464. [PMID: 36556080 PMCID: PMC9788016 DOI: 10.3390/jcm11247464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Vertebral Fractures (VFs) caused by osteoporosis are the most typical reason for performing Percutaneous Kyphoplasty (PK). Globally, VF prevalence is not well described in the literature. In Europe, only Sweden has an accurate record of the incidence of this type of fracture. Moreover, the exact incidence of the PK procedure is not reported. Therefore, the annual patterns and financial burden of PK in Europe is not well known, and it could be may better understood by examining national registers. For surgeons, lawmakers, hospital administrators, and the healthcare system, determining the annual national costs of this treatment is helpful. The National Hospital Discharge Reports (SDOs) submitted to the Italian Ministry of Health during the years covered by this study (2009-2015) were used. A total of 13,113 kyphoplasties were performed in Italy, with a prevalence of 3.6 procedures for every 100,000 Italian inhabitants over 15 years. The average age of patients was 68.28 (±12.9). Females represented the majority of patients undergoing PK procedures (68.6%). The median length of hospital stay was 5.33 days. The prevalence of PK procedures increased from 2009 to 2015, while the average days of hospitalization decreased. Older patients were most at risk in undergoing PK procedures. Reporting the national data on PK in Italy could also help compare the findings across nations. The current study aims to determine the trends of PK hospitalisation and patient features in Italy.
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21
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Jang HD, Kim EH, Lee JC, Choi SW, Kim HS, Cha JS, Shin BJ. Management of Osteoporotic Vertebral Fracture: Review Update 2022. Asian Spine J 2022; 16:934-946. [PMID: 36573301 PMCID: PMC9827207 DOI: 10.31616/asj.2022.0441] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few "gold standard treatments" outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%-35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate's effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Dongkang Hospital, Ulsan, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea,Corresponding author: Jae Chul Lee Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: +82-32-621-5114, Fax: +82-32-621-5018, E-mail:
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hak Soo Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joong-Suk Cha
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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22
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LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33:2049-2102. [PMID: 35478046 PMCID: PMC9546973 DOI: 10.1007/s00198-021-05900-y] [Citation(s) in RCA: 279] [Impact Index Per Article: 139.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) - formerly the National Osteoporosis Foundation - first published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above - 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.
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Affiliation(s)
- M. S. LeBoff
- grid.38142.3c000000041936754XBrigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115 USA
| | - S. L. Greenspan
- grid.412689.00000 0001 0650 7433University of Pittsburgh Medical Center, 1110 Kaufmann Building, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - K. L. Insogna
- grid.47100.320000000419368710Yale School of Medicine, 333 Cedar St, New Haven, CT 06520 USA
| | - E. M. Lewiecki
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, 300 Oak St NE, Albuquerque, NM 87106 USA
| | - K. G. Saag
- grid.265892.20000000106344187University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 820, Birmingham, AL 35294 USA
| | - A. J. Singer
- grid.411663.70000 0000 8937 0972MedStar Georgetown University Hospital and Georgetown University Medical Center, 3800 Reservoir Road NW, 3rd Floor, Washington, DC 20007 USA
| | - E. S. Siris
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, 180 Fort Washington Ave, Suite 9-903, New York, NY 10032 USA
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23
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Åkesson KE, Woolf AD. Osteoporosis and fragility fractures - Why is there still avoidable disability and death? Best Pract Res Clin Rheumatol 2022; 36:101792. [PMID: 36371364 DOI: 10.1016/j.berh.2022.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristina E Åkesson
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, TR1 3HD, UK.
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24
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Li Y, Tian J, Ge M, Ji L, Kang Y, Xia C, Zhang J, Huang Y, Feng F, Zhao T, Shao H. A Worldwide Bibliometric Analysis of Published Literature on Osteoporosis Vertebral Compression Fracture. J Pain Res 2022; 15:2373-2392. [PMID: 36003290 PMCID: PMC9395216 DOI: 10.2147/jpr.s375119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/05/2022] [Indexed: 01/02/2023] Open
Abstract
Background With the aging population growth in the world, the prevalence of osteoporotic vertebral compression fracture (OVCF) is rapidly increasing and receiving widespread attention. Although there are numerous articles on the topic, the research status and hotspot analysis are unclear. Objective The goal of this study is to identify trends in the OVCF field and to analyze the most highly cited original articles published in the Web of Science Index on OVCF using bibliometric analysis. Methods All OVCF data were obtained from the Web of Science Core Collection, and the number of citations, institutions, journals, countries, and years of publication in this field were visually analyzed using VOSviewer, the bibliometrics online analysis platform, and Excel software. Simultaneously, the top 100 most cited articles were extracted and analyzed. Results A total of 756 publications were related to OVCF were included from 1900 to 2022. In recent years, the number of articles on OVCF significantly increased. They are mainly from 41 countries/regions and 202 journals, led by China and the United States. Among all countries, China had the most significant contribution on OVCF (n = 363), and it also was cited most often (n = 3337). The institution with the most articles was Soochow University (n = 40). Osteoporosis International was the journal with most studies and has published 50 on this field. The journal of Spine was cited most often (n = 1968). The most productive periods were from 2016 to 2020, which received 294 articles and 4868 citations. After the analysis, the “vertebroplasty” and “kyphoplasty” of OVCF have been the most common research hotspots. Conclusion This study represents an updated bibliometric analysis of OVCF. The aim is to identify current research hotspots and future trends to guide clinicians and researchers in this field.
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Affiliation(s)
- Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Meng Ge
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Lichen Ji
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yao Kang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Chen Xia
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Jun Zhang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Fabo Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China.,Bengbu Medical College, Bengbu, People's Republic of China
| | - Haiyu Shao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, People's Republic of China
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25
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Gou P, Zhao Z, Yu C, Hou X, Gao G, Zhang T, Chang F. Efficacy of Recombinant Human Parathyroid Hormone versus Vertebral Augmentation Procedure on Patients with Acute Osteoporotic Vertebral Compression Fracture. Orthop Surg 2022; 14:2510-2518. [PMID: 36017765 PMCID: PMC9531108 DOI: 10.1111/os.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although widely used in clinical practice, vertebral augmentation procedure (VAP) for osteoporotic vertebral compression fracture (OVCF) is not supported. Recently, the effect of recombinant human parathyroid hormone (1-34) (rhPTH) has been paid great attention for its efficacy in anti-osteoporosis and bone union. This study aims to explore the outcome of rhPTH on acute OVCF and compare it with VAP to clarify its therapeutic advantages. METHODS The retrospective study comprised 71 acute OVCF patients from January 2015 to March 2020: 22 received rhPTH treatment (rhPTH group) and 49 underwent VAP (VAP group). The rhPTH group was 15 women and seven men with an average of 76.18 years, and the VAP group were 35 women and 14 men with an average of 73.63 years. The thoracic/lumbar vertebrae were 14/8 in the rhPTH group and 29/20 in the VAP group. The average follow-up period was 14.05 months in the rhPTH group and 13.82 months in the VAP group. The two groups were assessed regarding the visual analog score (VAS), Oswestry Disability Index (ODI), OVCF bone union, bone mineral density (BMD), kyphotic angle (KA), anterior and posterior border height (ABH and PBH, respectively), adverse events and the health-related quality of life assessed by short form-36 health survey scores (SF-36). Categorical variables were analyzed by chi-square test and continuous variables between groups were analyzed by independent samples t-test or Mann-Whitney U test according to the normality. RESULTS During the follow-up, the VAS was significantly lower in the rhPTH group than in the VAP group at month 3 (0.39 ± 0.6 vs 0.68 ± 0.651) (p = 0.047), month 6 (0.45 ± 0.60 vs 2.18 ± 1.22) (p < 0.001), and month 12 (0.45 ± 0.60 vs 2.43 ± 1.49) (p < 0.001). At month 12, the ODI was significantly lower in the rhPTH group (18.59 ± 3.33%) than in the VAP group (28.93 ± 16.71%) (p < 0.001). Bone bridge was detected on sagittal computed tomography images of all fractured vertebrae in the rhPTH group. The BMD was significantly higher in the rhPTH group (87.66 ± 5.91 Hounsfield units [HU]) than in the VAP group (68.15 ± 11.32HU) (p < 0.001). There were no significant differences in the changes in KA, ABH, and PBH between groups (all p > 0.05). The incidence of new OVCF was significantly lower in the rhPTH group than in the VAP group (p = 0.042). All scores of SF-36 were significantly higher in the rhPTH group than in the VAP group (all p < 0.05). CONCLUSION In acute OVCF patients, rhPTH was better than VAP in increasing spinal BMD to promote OVCF healing, reduce new OVCF, and improve back pain, physical ability, and health-related quality of life.
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Affiliation(s)
- Pengguo Gou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhihui Zhao
- Department of Orthopedic Surgery, The Tianjin 4th Centre Hospital, Tianjin, Tianjin, China
| | - Chen Yu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuefeng Hou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Gang Gao
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ting Zhang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feng Chang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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26
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Clinical Effect of Bone Filling Mesh Container Vertebroplasty in Osteoporotic Compression Fracture. DISEASE MARKERS 2022; 2022:5029679. [PMID: 35958282 PMCID: PMC9363223 DOI: 10.1155/2022/5029679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the clinical application of bone filling mesh container vertebroplasty in osteoporotic vertebral compression fractures (OVCFs). Methods Patients with OVCF from October 2018 to April 2020 were selected. Patients in the control and study groups underwent percutaneous kyphoplasty (PKP) and bone filling mesh container vertebroplasty, respectively. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), visual analog scale (VAS) scores before and after surgery, and the incidence of complications were compared between the two groups. Results The operation time and fluoroscopy time of the study group were significantly lower than those of the control group (P < 0.05). There was no significant difference in the injection volume of bone cement between the study group and the control group (P > 0.05). There was no significant difference in Cobb angle between the two groups. Three months after the operation, the height of the anterior edge increased and the Cobb angle decreased in the two groups (P < 0.05), but there was no significant difference in the height of the anterior edge and the Cobb angle between the two groups (P > 0.05). The JOA scores increased, while the ODI and VAS scores decreased in both groups after surgery (P < 0.05). There was no significant difference in the total effective rate between the study group (96.15%) and the control group (92.31%) (P > 0.05). The incidence of complications in the study group (3.85%) was significantly lower than that in the control group (15.38%) (P < 0.05). Conclusions For the treatment of OVCFs, bone filling mesh container vertebroplasty is comparable to PKP in terms of functional recovery, but it can safely reduce operative time, fluoroscopy time, and complication rates.
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27
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Hogan WB, Philips A, Alsoof D, McDonald CL, Anderson G, Zhang AS, Daniels AH. Kyphoplasty and Vertebroplasty Performed by Surgeons versus Nonsurgeons: Trends in Procedure Rates, Complications, and Revisions. World Neurosurg 2022; 164:e518-e524. [PMID: 35552034 DOI: 10.1016/j.wneu.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vertebral compression fractures are the most common fragility fractures affecting osteoporotic patients. This study evaluated volume trends and outcomes across specialties performing cement augmentation procedures. METHODS Patients were identified using Current Procedural Terminology codes for vertebroplasty or kyphoplasty from 2010 to 2019. Patients were grouped by surgical providers (orthopedic surgery and neurological surgery) or nonsurgical providers (anesthesia, pain medicine, radiology, and physical medicine and rehabilitation). Outcomes recorded included reoperation rates and postoperative complications occurring within 30 days. Logistic regression was employed to account for potential confounding variables, and odds ratios were obtained. RESULTS Inclusion criteria were met by 80,864 patients who received cement augmentation. Surgeon specialists performed 51.7% of all procedures. Of procedures carried out by nonsurgeon specialists, radiologists performed the most. Despite a stable number of procedures performed over the period, the percentage of procedures performed by surgeons decreased from 58.8% to 49.9% (P < 0.001). Patients with procedures performed by surgeons experienced lower odds of reoperation at 30 days (P < 0.001) and 1 year (P < 0.001), but 5-year and overall rates were not significant (P > 0.05). Surgical patients had lower odds of acute kidney injury (P < 0.004) and pulmonary embolism (odds ratio = 0.62, P < 0.001), yet increased odds of surgical site infection (P < 0.001). CONCLUSIONS Kyphoplasties and vertebroplasties are increasingly performed by nonsurgeon specialists. Although early reoperation rates are higher for nonsurgeon specialists, 5-year and overall reoperation rates were similar. Differing complication rates may relate to patient selection rather than operative technique and can be investigated with future studies.
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Affiliation(s)
- William B Hogan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alexander Philips
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - George Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew S Zhang
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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Therapeutic Efficacy of Third-Generation Percutaneous Vertebral Augmentation System (PVAS) in Osteoporotic Vertebral Compression Fractures (OVCFs): A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9637831. [PMID: 35578725 PMCID: PMC9107362 DOI: 10.1155/2022/9637831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Purpose This study aimed to assess whether the third-generation PVAS was superior to percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating patients with OVCFs. Methods Databases, including Pubmed, Embase, and Cochrane library, were searched to identify relevant interventional and observational articles in vivo or in vitro comparing the third-generation PVAS to PVP/PKP in OVCFs patients. A meta-analysis was performed under the guidelines of the Cochrane Reviewer's Handbook. Results 11 in vivo articles involving 1035 patients with 1320 segments of diseased vertebral bodies and 8 in vitro studies enrolling 40 specimens with 202 vertebral bodies were identified. The vivo studies indicated no significant differences were found in visual analog scale (VAS), Oswestry Disability Index (ODI), operation time, or injected cement volume (P > 0.05). The third-generation PVAS was associated with significant improvement in vertebral height and Cobb angle (P < 0.05) and also with a significantly lower risk of cement leakages and new fractures (P < 0.05). The vitro studies suggest that the third-generation PVAS was associated with better anterior vertebral height (AVH) and kyphotic angle (KA) after deflation and cement. No significant differences were found in stiffness or failure load after cement between the two groups (P > 0.05). Conclusion Based on current evidence, although providing similar improvement in VAS and ODI, the third-generation PVAS may be superior to PVP/PKP in local kyphosis correction, vertebral height maintenance, and adverse events reduction. Further high-quality randomized studies are required to confirm these results.
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Abstract
Pregnancy-associated osteoporosis (PAO) is a rare condition of skeletal fragility affecting women in pregnancy or the postpartum period. During normal pregnancy and lactation, substantial changes in calcium metabolism and skeletal physiology occur in order to meet the demands of the developing foetus. Whilst these adaptations are reversible and generally of no clinical consequence for the mother, a small number of women will develop osteoporosis and suffer fragility fractures. Vertebral fractures occur most commonly in PAO and are often multiple. Due to the rarity of PAO, systematic study to date has been limited. Aetiology is poorly understood, but traditional osteoporosis risk factors and genetic factors are likely to play a role. A small number of cases may be due to an underlying metabolic bone disorder or monogenic condition. Management of PAO is challenging, due both to a poor evidence base and the fact that spontaneous improvement in BMD is known to occur once pregnancy and lactation are complete. Bisphosphonates, denosumab and teriparatide have all been used in individual patients, but the data supporting their use are currently limited.
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Giangregorio L, Ponzano M. Letter to the Editor on "Effects of Two Newly Developed Spinal Orthoses on Trunk Muscle Strength, Posture, and Quality-of-Life in Women With Postmenopausal Osteoporosis: A Randomized Trial". Am J Phys Med Rehabil 2022; 101:e81-e82. [PMID: 35034051 DOI: 10.1097/phm.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vilaca T, Eastell R, Schini M. Osteoporosis in men. Lancet Diabetes Endocrinol 2022; 10:273-283. [PMID: 35247315 DOI: 10.1016/s2213-8587(22)00012-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/18/2022]
Abstract
Osteoporosis in men is a common but often overlooked disorder by clinicians. The criterion for osteoporosis diagnosis in men is similar to that in women-namely, a bone mineral density (BMD) that is 2·5 standard deviations or more below the mean for the young adult population (aged 20-29 years; T-score -2·5 or lower), measured at the hip or lumbar spine. Sex steroids are important for bone health in men and, as in women, oestrogens have a key role. Most men generally have bigger and stronger bones than women and typically have less bone loss during their lifetime. Men typically fracture less often than women, although they have a higher mortality rate after a fracture. Secondary osteoporosis is more common in men than in women. Lifestyle changes, adequate calcium, vitamin D intake, and exercise programmes are recommended for the management of osteoporosis in men. Bisphosphonates, denosumab, and teriparatide have been shown to increase BMD and are used for pharmacological treatment. In this Review, we report an updated overview of osteoporosis in men, describe new treatments and concepts, and discuss persistent controversies in the area.
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Affiliation(s)
- Tatiane Vilaca
- Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK.
| | - Richard Eastell
- Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Marian Schini
- Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
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Abstract
This is a review of evidence and practical tips on exercise for individuals with osteoporosis, including individuals with hip and vertebral fractures. Balance and functional training, with or without strength training, can prevent falls. Several types of exercise can improve outcomes that are important to patients, such as physical functioning or quality of life. Individuals with osteoporosis should prioritize balance, functional and resistance training ≥ twice weekly, where exercises, volume, intensity, and progression are aligned with the patient's goals and abilities. Patients who want to participate in other activities (e.g., walking, impact exercise, yoga, Pilates) can do them in addition to, but not instead of, balance and functional or strength training, if they can be done safely or modified. Avoid generic advice like "Don't bend or twist", which is difficult or impossible to operationalize, and may create fear and activity avoidance. Instead, be specific about the types of activities to avoid or modify, and provide tips on how to make daily activities safer, or signpost to resources from national osteoporosis societies. For example, not all bending or twisting is bad; it is activities that involve rapid, repetitive, sustained, weighted, or end range of motion twisting or flexion of the spine that may need to be modified, especially in individuals at high risk of fracture.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2K 2N1, Canada
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Laurent MR, Goemaere S, Verroken C, Bergmann P, Body JJ, Bruyère O, Cavalier E, Rozenberg S, Lapauw B, Gielen E. Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club. Front Endocrinol (Lausanne) 2022; 13:908727. [PMID: 35757436 PMCID: PMC9219603 DOI: 10.3389/fendo.2022.908727] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids are effective immunomodulatory drugs used for many inflammatory disorders as well as in transplant recipients. However, both iatrogenic and endogenous glucocorticoid excess are also associated with several side effects including an increased risk of osteoporosis and fractures. Glucocorticoid-induced osteoporosis (GIOP) is a common secondary cause of osteoporosis in adults. Despite availability of clear evidence and international guidelines for the prevention of GIOP, a large treatment gap remains. In this narrative review, the Belgian Bone Club (BBC) updates its 2006 consensus recommendations for the prevention and treatment of GIOP in adults. The pathophysiology of GIOP is multifactorial. The BBC strongly advises non-pharmacological measures including physical exercise, smoking cessation and avoidance of alcohol abuse in all adults at risk for osteoporosis. Glucocorticoids are associated with impaired intestinal calcium absorption; the BBC therefore strongly recommend sufficient calcium intake and avoidance of vitamin D deficiency. We recommend assessment of fracture risk, taking age, sex, menopausal status, prior fractures, glucocorticoid dose, other clinical risk factors and bone mineral density into account. Placebo-controlled randomized controlled trials have demonstrated the efficacy of alendronate, risedronate, zoledronate, denosumab and teriparatide in GIOP. We suggest monitoring by dual-energy X-ray absorptiometry (DXA) and vertebral fracture identification one year after glucocorticoid initiation. The trabecular bone score might be considered during DXA monitoring. Extended femur scans might be considered at the time of DXA imaging in glucocorticoid users on long-term (≥ 3 years) antiresorptive therapy. Bone turnover markers may be considered for monitoring treatment with anti-resorptive or osteoanabolic drugs in GIOP. Although the pathophysiology of solid organ and hematopoietic stem cell transplantation-induced osteoporosis extends beyond GIOP alone, the BBC recommends similar evaluation, prevention, treatment and follow-up principles in these patients. Efforts to close the treatment gap in GIOP and implement available effective fracture prevention strategies into clinical practice in primary, secondary and tertiary care are urgently needed.
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Affiliation(s)
- Michaël R. Laurent
- Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Geriatrics, Imelda Hospital, Bonheiden, Belgium
- *Correspondence: Michaël R. Laurent,
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Verroken
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
| | - Serge Rozenberg
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Evelien Gielen
- Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
- Gerontology and Geriatrics section, Department of Public Health and Primary Care, University Hospitals Leuven and KU Leuven, Leuven, Belgium
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He XY, Yu HM, Lin S, Li YZ. Advances in the application of mesenchymal stem cells, exosomes, biomimetic materials, and 3D printing in osteoporosis treatment. Cell Mol Biol Lett 2021; 26:47. [PMID: 34775969 PMCID: PMC8591870 DOI: 10.1186/s11658-021-00291-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/02/2021] [Indexed: 01/01/2023] Open
Abstract
Owing to an increase in the aging population, osteoporosis has become a severe public health concern, with a high prevalence among the elderly and postmenopausal adults. Osteoporosis-related fracture is a major cause of morbidity and mortality in elderly and postmenopausal adults, posing a considerable socioeconomic burden. However, existing treatments can only slow down the process of osteoporosis, reduce the risk of fractures, and repair fractures locally. Therefore, emerging methods for treating osteoporosis, such as mesenchymal stem cell transplantation, exosome-driving drug delivery systems, biomimetic materials, and 3D printing technology, have received increasing research attention, with significant progress. Mesenchymal stem cells (MSCs) are pluripotent stem cells that can differentiate into different types of functional cells. Exosomes play a key role in regulating cell microenvironments through paracrine mechanisms. Bionic materials and 3D printed scaffolds are beneficial for the reconstruction and repair of osteoporotic bones and osteoporosis-related fractures. Stem cells, exosomes, and biomimetic materials represent emerging technologies for osteoporosis treatment. This review summarizes the latest developments in these three aspects.
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Affiliation(s)
- Xiao-Yu He
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Hai-Ming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China. .,Diabetes and Metabolism Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Yi-Zhong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
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Tabata Y, Matsui S, Miyamoto M, Nakajima T, Majima T. The Relationship between Perivertebral Venous Cement Embolism and Balloon Expansion Pressure in Balloon Kyphoplasty. JMA J 2021; 4:367-373. [PMID: 34796291 PMCID: PMC8580707 DOI: 10.31662/jmaj.2021-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Osteoporotic vertebral compression fractures (OVCFs) are common fractures in the elderly suffering osteoporosis. Most patients have bone fusion with deformity of vertebral collapse; however, some patients suffer nonunion and persistent pain at the fracture site. Due to the limitations of conservative treatment, balloon kyphoplasty (BKP) has been recently performed for OVCFs. This study aimed to investigate the relationship between cement embolization and balloon expansion pressure (BEP) in patients who underwent BKP. Methods We investigated 62 patients who underwent BKP for cement embolization into the perivertebral veins among the 155 patients admitted to our hospital due to thoracolumbar vertebral compression fractures between April 1, 2019, and March 31, 2020. Surgery was indicated for patients who had severe back or low back pain and whose daily life was severely impaired, and in whom the shape of the vertebral body was clearly changed on functional X-ray. Results Intraoperative X-ray and postoperative CT revealed cement embolization into the perivertebral veins in three cases (4.83%). The BEP was significantly higher in the group with cement embolism than in the group without cement embolism (P < 0.001). Pulmonary cement embolism (PCE) and infection were not observed. One case of cement leakage into the spinal canal was observed (1.61%). Conclusions While the surgical intervention of BKP can contribute to the treatment of OVCFs, careful attention should be paid to the prevention of complications, including cement embolization into the perivertebral veins, and such complications should be appropriately managed.
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Affiliation(s)
- Yusuke Tabata
- Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan.,Department of Orthopedic Surgery, Musashino General Hospital, Saitama, Japan.,Department of Orthopedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shuhei Matsui
- Department of Orthopedic Surgery, Musashino General Hospital, Saitama, Japan
| | - Masabumi Miyamoto
- Department of Orthopaedic Surgery, Sekishindo Hospital, Saitama, Japan
| | - Takao Nakajima
- Department of Orthopedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Tokifumi Majima
- Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan
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Roux C, Cortet B, Bousson V, Thomas T. Vertebroplasty for osteoporotic vertebral fracture. RMD Open 2021; 7:rmdopen-2021-001655. [PMID: 34193518 PMCID: PMC8246346 DOI: 10.1136/rmdopen-2021-001655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Appropriate care of patients with a recent painful osteoporotic vertebral fracture (VF) requires immobilisation, analgesics and spinal orthoses. Some VFs are however responsible for disabling pain and prolonged bed rest. In this context, vertebroplasty techniques have been proposed with a large benefit in case series and open-label randomised studies, but lack efficacy in three among four double-blind randomised studies. The objectives of the treatment of a recent painful VF are to relieve pain and to preserve mechanical conditions. With this in mind, we report an experts’ opinion paper on the indications for vertebroplasty and research agenda for clinical studies.
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Affiliation(s)
- Christian Roux
- INSERM U1153, APHP.Centre-Université de Paris, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Bernard Cortet
- Department of Rheumatology, ULR 4490, Université de Lille, Lille University Hospital, Lille, France
| | - Valérie Bousson
- Service de Radiologie Ostéo-Articulaire, APHP.Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, and INSERM U 1059, Université de Lyon-Université Jean Monnet, CHU de St-Etienne, Saint-Etienne, France
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Gold LS, O'Reilly MK, Heagerty PJ, Jarvik JG. Complications and healthcare utilization in commercially-insured osteoporotic vertebral compression fracture patients: a comparison of kyphoplasty versus propensity-matched controls. Spine J 2021; 21:1347-1354. [PMID: 33781968 PMCID: PMC8349787 DOI: 10.1016/j.spinee.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVFs) can lead to severe pain and reduced function and quality-of-life, but the strength of evidence for treatments remains low, particularly in younger populations. PURPOSE To determine whether patients with OVFs who received kyphoplasty had different patterns of healthcare utilization compared to propensity-matched patients who did not receive vertebral augmentation. DESIGN Observational cohort study. PATIENT SAMPLE We identified patients with OVFs from 2007 to 2018 in the IBM MarketScan Commercial Claims and Encounters Databases who received kyphoplasty and compared them to propensity-matched controls who did not receive vertebral augmentation (either kyphoplasty or vertebroplasty). OUTCOME MEASURES Major medical complications within 30 days, fills of opioids from 1-week through 1-month postaugmentation, and spine-related gross covered payments from 3-days postkyphoplasty through 1-year post-OVF. METHODS We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs) to compare binary outcomes and median analysis to compare continuous outcomes. RESULTS Of the 15,197 OVF patients identified, 1,969 (13%) received kyphoplasty and 1,928 (98%) of these were propensity matched to nonaugmented controls. We did not observe differences in the odds of major medical complications within 30 days (adjusted OR [95% CI]: 1.0 [0.6, 1.8]) but patients who received kyphoplasty were more likely to have filled opioid medications within 30 days (adjusted OR [95% CI]: 1.3 [1.1, 1.5]) and had greater spine-related gross covered payments (kyphoplasty median [95% CI]: $1,340 [$240, $4,850]; nonaugmented: $7,870 [$7,480, $8,270]; adjusted difference in medians [95% CI]: $260 [$190, $2,050]). CONCLUSIONS In this cohort of patients <65 years, receipt of kyphoplasty was associated with greater likelihood of opioid fills and somewhat greater spine-related gross covered payments, but no difference in major medical complications. In this retrospective study of administrative data, we did not detect advantages of treatment with kyphoplasty compared with nonaugmentation for any of our outcomes.
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Affiliation(s)
- Laura S Gold
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
| | - Michael K O'Reilly
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
| | - Patrick J Heagerty
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jeffrey G Jarvik
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA
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Kweh BTS, Lee HQ, Tan T, Rutges J, Marion T, Tew KS, Bhalla V, Menon S, Oner FC, Fisher C, Tee JW. The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review. Global Spine J 2021; 11:975-987. [PMID: 32990034 PMCID: PMC8258809 DOI: 10.1177/2192568220948036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. METHODS A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. RESULTS Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. CONCLUSION The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia,Barry Ting Sheen Kweh, National Trauma Research Institute, 85-89 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence Tan
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Travis Marion
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | | | | | | | - Charles Fisher
- University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria, Australia,The Alfred Hospital, Melbourne, Victoria, Australia
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Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Tokuhashi Y. Preoperative scoring system for predicting early adjacent vertebral fractures after Balloon Kyphoplasty. J Orthop Sci 2021; 26:538-542. [PMID: 32709541 DOI: 10.1016/j.jos.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjacent vertebral fracture (AVF) is a major complication following Balloon Kyphoplasty (BKP). There is no scoring system for predicting AVF using only preoperative elements. The purposes of this study were to develop a scoring system for predicting early AVF after BKP based on preoperative factors and to investigate the appropriate surgical indication for BKP. METHODS Of 220 patients who underwent BKP at a single institution since 2011, 65 patients over the age of 60 who had undergone a standing whole spine X-ray preoperatively were enrolled. Factors affecting the occurrence of early AVF were examined. A scoring system was created consisting of the factors exhibiting significant differences, and the correlation between the total score and the incidence of early AVF was investigated. RESULTS Twenty of the 65 patients (30.8%) had early AVF. In a univariate analysis, age, previous vertebral fracture, pelvic tilt, and Local kyphosis significantly influenced early AVF. In a multivariate logistic regression analysis, age had an odds ratio of 1.136 (95% CI 1.001-1.289), previous vertebral fractures 4.181 (1.01-17.309), and Local kyphosis 1.103 (1.021-1.191). The scoring system was set as follows: ①Age (<75 years: 0 points(P), 75years≦: 1P), ②The number of previous vertebral fractures (0: 0 P, 1: 1P, 2: 2P, 3 or more: 3P), and ③Local kyphosis (<10°: 0P, 10°≦: 1P). There was a correlation between the total score and the incidence of early AVF (r = 0.812, ∗P = 0.05). The incidence of early AVF was 6.4% (2 cases/31 cases) for a score of ≦1P and 54.5% (18 cases/33 cases) for a score of ≧2P. CONCLUSIONS There was a correlation between the total score and the incidence of early AVF. A score of 1 point or less may represent the appropriate surgical indication for BKP.
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Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan
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Xiao Q, Zhao Y, Qu Z, Zhang Z, Wu K, Lin X. Association Between Bone Cement Augmentation and New Vertebral Fractures in Patients with Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 153:98-108.e3. [PMID: 34139353 DOI: 10.1016/j.wneu.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the association between bone cement augmentation and new vertebral fractures (VF) in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS A literature search of PubMed, EMBASE, and the Cochrane Library was conducted from 1987 to December 31, 2020, to identify randomized controlled trials that compared bone cement augmentation with non-bone cement treatments in patients with OVCFs. The clinical incidence of new VF and the risk of new adjacent vertebral fractures (AVF) after treatment were calculated. The indexes of the risk ratio or odds ratio, and 95% confidence intervals were determined with RevMan 5.2 software. RESULTS A total of 13 randomized controlled trials involving 1949 participants were included in the final quantitative analysis. There was no significant association between bone cement augmentation and the clinical incidence of new VF during the 6-month and 12-month follow-ups or the whole follow-up period. However, there was a significantly lower clinical incidence of new VF in patients who received bone cement augmentation compared with non-bone cement treatments during 24 months or more of follow-up. Pooled data from the relevant trials demonstrated that the risk of new AVF in bone cement augmentation was significantly higher than that in non-bone cement treatments. CONCLUSIONS Although the use of bone cement augmentation in OVCFs significantly increased the risk of new AVF compared with non-bone cement treatments, it was not significantly associated with a higher clinical incidence of new VF.
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Affiliation(s)
- Qinghua Xiao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China; Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Ying Zhao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Qu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Zhang
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Keliang Wu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Xiaosheng Lin
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China.
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Cazzato RL, Bellone T, Scardapane M, De Marini P, Autrusseau PA, Auloge P, Garnon J, Jennings JW, Gangi A. Vertebral augmentation reduces the 12-month mortality and morbidity in patients with osteoporotic vertebral compression fractures. Eur Radiol 2021; 31:8246-8255. [PMID: 33899142 DOI: 10.1007/s00330-021-07985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/26/2021] [Accepted: 04/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the 12-month all-cause mortality and morbidity in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebroplasty/balloon kyphoplasty (VP/BKP) versus non-surgical management (NSM). METHODS Following a Medline and EMBASE search for English language articles published from 2010 to 2019, 19 studies reporting on mortality and morbidity after VP/BKP in patients with OVCFs were selected. The 12-month timeline was set due to the largest amount of data availability at such time interval. Estimates for each study were reported as odds ratios (OR) along with 95% confidence intervals (CI) and p values. Fixed or random-effects meta-analyses were performed. All tests were based on a two-sided significance level of 0.05. RESULTS Pooled OR across 5 studies favored VP/BKP over NSM in terms of 12-month all-cause mortality (OR: 0.81 [95% CI: 0.46-1.42]; p = .46). Pooled OR across 11 studies favored VP/BKP over NSM in terms of 12-month all-cause morbidity (OR: 0.64 [95% CI: 0.31-1.30]; p = .25). Sub-analysis of data dealing with 12-month infective morbidity from any origin confirmed the benefit of VP/BKP over NSM (OR: 0.23 [95% CI, 0.02-2.54]; p = .23). CONCLUSION Compared to NSM, VP/BKP reduces the 12-month risk of all-cause mortality and morbidity by 19% and 36%, respectively. Moreover, VP/BKP reduces by 77% the 12-month risk of infection from any origin. KEY POINTS • Compared to non-surgical management, vertebral augmentation reduces the 12-month risk of all-cause mortality by 19% and all-cause morbidity by 36%. • Vertebral augmentation reduces the 12-month risk of infection morbidity from any origin by 77%.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.
| | | | | | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre-Alexis Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l'hôpital, 67000, Strasbourg, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Gupta A, Cha T, Schwab J, Fogel H, Tobert D, Cho S, Hecht A, Bono CM, Hershman S. Males Have Higher Rates of Peri-operative Mortality Following Surgery for Osteoporotic Vertebral Compression Fracture. Osteoporos Int 2021; 32:699-704. [PMID: 32929524 DOI: 10.1007/s00198-020-05630-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED In this study, we evaluated the association between sex and the incidence of postoperative mortality in the peri-operative period following surgical intervention for OVCF. We found no statistical association between surgical complications and patient sex. However, males exhibited higher rates of mortality and 30-day readmissions relative to females. INTRODUCTION Osteoporotic vertebral compression fractures (OVCF) contribute substantially to the financial burden of the US healthcare system. As the size of the elderly population grows, the number of fractures attributed to osteoporosis is expected to increase. Studies have shown that osteoporotic patients are at an increased risk for medical and surgical complications. The purpose of this study was to evaluate the association between sex and the incidence of postoperative mortality in the peri-operative period following surgical intervention for OVCF. METHODS A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients. Patients were grouped as male or female. Mortality within 30 days of surgery due to any cause, incidence of surgical complications, and 30-day readmission rates following surgery were tabulated. A multivariate logistic regression analysis was conducted to calculate odds ratios (OR) with corresponding p values and 95% confidence intervals. RESULTS In total, 1979 patients met inclusion and exclusion criteria. Mortality within the 30 days following surgery for OVCF was statistically greater in men than in women (OR = 1.58; p = 0.050). The 30-day readmission rate was also statistically higher in men (OR = 1.41; p = 0.017). Neither minor (OR = 0.90; p = 0.560) nor major (OR = 1.14; p = 0.569) complications were statistically correlated with sex. On average, men underwent surgery for OVCF at a younger age than women. CONCLUSIONS Male patients undergoing surgery for OVCF have higher rates of peri-operative mortality and 30-day readmissions following surgery. Sex was not found to be associated with postoperative complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Gupta
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Mount Sinai Hospital, 425 West 59th St., New York, NY, 10019, USA
| | - T Cha
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
| | - J Schwab
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
| | - H Fogel
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
| | - D Tobert
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
| | - S Cho
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Mount Sinai Hospital, 425 West 59th St., New York, NY, 10019, USA
| | - A Hecht
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Mount Sinai Hospital, East 98th St., New York, NY, 10029, USA
| | - C M Bono
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA
| | - S Hershman
- Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA.
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Díaz-Romero R, Henríquez MS, Melián KA, Balhen-Martin C. Practice Patterns of Spine Surgeons Regarding Osteoporosis: An International Survey. Int J Spine Surg 2021; 15:376-385. [PMID: 33900997 PMCID: PMC8059382 DOI: 10.14444/8049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Osteoporosis (OP) represents a great challenge for the spine surgeon. Despite having effective pharmacological treatments for OP and surgical technical innovations, the awareness of spine surgeons regarding OP seems low. The purpose of this research was to assess practice patterns on the diagnosis and treatment of spine surgeons regarding OP. METHODS An electronic survey of ten multiple-choice questions was administered to members of the European Association of Neurosurgical Societies (EANS). The survey asked about the specialty, the workplace, and practice patterns and attitudes regarding OP and spine fusion surgery, pseudoarthrosis, and vertebral compression fractures (VCF). RESULTS A total of 122 surgeons completed the survey. In patients with suspected OP, 31.4% of surgeons would refer the patient to the OP specialist before surgery and 21.5% chose to perform the surgery without additional studies. A 66.4% of respondents would modify the surgical strategy in the case of OP. The most popular surgical techniques elected were cemented augmented screws (77.9%) and long-segment instrumentation (45.1%). Regarding pseudoarthrosis, 29.5% of surgeons opted to refer to the OP specialist, and 23.8% didn't consider any additional studies Concerning VCF management, 41.32% of respondents would refer the patient for treatment of OP, and the most common therapeutic strategy was conservatively treatment for 4 to 6 weeks and vertebroplasty or kyphoplasty if no improvement (55.74%).There was a higher proportion of surgeons that would not consider preoperative studies or referring patients with suspected OP for spine surgery (χ2 = 4.48, P = .03) and pseudoarthrosis (χ2 = 9.5, P = .002) compared to VCF. CONCLUSIONS There was a greater awareness regarding optimizing OP management in VCF compared to patients with suspected OP for spine arthrodesis or pseudoarthrosis. There still opportunities for improvement for the timely diagnosis and treatment of OP in spine surgery patients.
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Affiliation(s)
- Ricardo Díaz-Romero
- Universidad de Las Palmas de Gran Canaria, Spain
- Department of Neurosurgery of Hospital Insular of Las Palmas of Spain Neurosurgery
| | - Manuel Sosa Henríquez
- Universidad de Las Palmas de Gran Canaria, Spain
- Department Bone Metabolism and Osteoporosis of Hospital Insular of Las Palmas, Spain
| | - Kevin Armas Melián
- Department of Neurosurgery of Hospital Insular of Las Palmas of Spain Neurosurgery
| | - Claudia Balhen-Martin
- Department of Radiology, Hospital Perpetuo Socorro, Las Palmas de Gran Canaria, Spain
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Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ. Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review. Asian Spine J 2020; 14:898-909. [PMID: 33373513 PMCID: PMC7788360 DOI: 10.31616/asj.2020.0594] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungbum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Medicare Utilization and Reimbursement for Vertebroplasty and Kyphoplasty: A National Analysis From 2012-2017. Spine (Phila Pa 1976) 2020; 45:1744-1750. [PMID: 32925685 DOI: 10.1097/brs.0000000000003692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study OBJECTIVE.: This study seeks to identify recent trends in utilization and reimbursements of these procedures between 2012and 2017, a period which experienced a change in national guideline recommendations for these procedures. SUMMARY OF BACKGROUND DATA Minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been typically reserved for fractures associated with refractory pain, deformity, or progressive neurological symptoms. However, controversy exists regarding the safety and effectiveness of these procedures, in particular vertebroplasty. METHODS Annual Medicare claims and payments to surgeons were aggregated at the county level to assess regional trends. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to examine associations between county-specific variables and outcome variables. RESULTS A total of 24,316 vertebroplasties and 138,778 kyphoplasties were performed in the Medicare population between 2012 and 2017. Annual vertebroplasty volume fell by 48.0% from 5744 procedures in 2012 to 2987 in 2017, with a compound annual growth rate (CAGR) of -12.3%. Annual kyphoplasty volume also declined by 12.7% (CAGR -2.7%), from 24,986 in 2012 to 21,681 in 2017. Surgeon reimbursements for vertebral augmentation procedures increased by a weighted average of 93.7% (inflation-adjusted increase of 78.2%) between 2012 and 2017, which was primarily driven by a dramatic 113.3% (inflation-adjusted increase of 96.2%) increase in mean reimbursements for kyphoplasty procedures from an average of $895 to $1764, between 2012 and 2017, respectively. CONCLUSION This large national Medicare database study found that vertebroplasty and kyphoplasty procedure volume and utilization of both procedures have declined significantly. Although average reimbursements to surgeons for vertebroplasties have significantly declined, payments for kyphoplasty procedures have risen significantly. Although vertebroplasty volume has significantly decreased, it is still being performed and being reimbursed for, in spite of its controversial role in its treatment of vertebral fractures. LEVEL OF EVIDENCE 3.
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Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion. Eur Radiol 2020; 30:5641-5649. [PMID: 32367420 DOI: 10.1007/s00330-020-06889-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Vertebral augmentation (VA) has become routinely used in vertebral compression fractures (VCFs). VCFs are often associated with posterior wall protrusions (PWPs), which theoretically contraindicates vertebroplasty due to a higher risk of neurological complications. The latest generation of VA devices uses intravertebral cranio-caudal expandable implants to improve the correction of structural deformities but could also be used to prevent further PWP during cement injection. The aim of this study was to evaluate the safety of VA with expandable implant for VCFs with PWP. METHODS All consecutive patients treated with expandable implants were considered eligible for inclusion if they met the following criteria: (1) non-neurological VCF, (2) considered unstable (A3-A4 in AOSpine classification), (3) significant PWP (> 2 mm), (4) back pain with a visual analogue scale (VAS) ≥ 4. PWPs were independently measured by two investigators; Pearson's statistics were used for interobserver reproducibility. RESULTS Fifty-one consecutive patients, with a mean age of 75 ± 8.3 years (range, 50-92), were included. There was a slight decrease between mean preoperative (6.7 mm ± 2.2 mm) and postoperative (6.5 mm ± 2.2 mm) PWP (p = 0.02), with an excellent interobserver reproducibility (Pearson correlation coefficient = 0.92). A mean kyphosis reduction of 34.9% (± 28.4) was observed (p < 0.001). Forty-two patients (82.4%) had significant pain improvements (mean preoperative VAS = 6.9 [± 1.7] versus 3.1 [± 2.0] postoperatively [p < 0.001]). Secondary adjacent level fractures were noted in 16 patients (31.4%), with a reduction of that risk down to 18.8% if a preventive adjacent vertebroplasty was performed, without reaching the significance threshold (p = 0.14). CONCLUSIONS VA with expandable implants appeared safe for non-neurological VCFs with PWP, while allowing satisfactory pain relief. KEY POINTS • Vertebral augmentation with cranio-caudal expandable implants is safe for non-neurological vertebral compression fractures with posterior wall protrusions. • Vertebral augmentation with cranio-caudal expandable implants might increase the occurrence of secondary adjacent level fractures. • Adjacent level vertebroplasty might be helpful to prevent secondary adjacent level fractures.
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Diamond T, Clark W, Bird P, Gonski P, Barnes E, Gebski V. Early vertebroplasty within 3 weeks of fracture for acute painful vertebral osteoporotic fractures: subgroup analysis of the VAPOUR trial and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1606-1613. [PMID: 32170438 DOI: 10.1007/s00586-020-06362-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND VAPOUR found vertebroplasty (V) more effective than placebo (P) in patients with severe pain and fracture duration less than 6 weeks. Exploratory analysis suggested that benefits were concentrated in the subgroup of patients with fractures ≤ 3-week duration. This difference may account for the three negative blinded trials that included few patients within this fracture time frame. PURPOSE To assess the safety and efficacy of early vertebroplasty for acute painful vertebral osteoporotic fractures within 3 weeks of fracture onset in the VAPOUR study. METHODS Spearman's rank log coefficients were calculated to reassess the relationship of pain reduction from vertebroplasty and fracture duration in the VAPOUR trial. We more fully report baseline and outcome data in patients with fractures ≤ 3-week duration. RESULTS There were 46V and 47P patients with fractures ≤ 3-week duration. Baseline characteristics were similar. In total, 86 patients (41V, 45P) completed the 14-day questionnaire. The proportion of patients with reduction in pain from severe (NRS ≥ 7/10 was an inclusion requirement) to mild (NRS < 4) at 14 days was 21 (51%) V-group and 9 (20%) in the P-group (between-group difference 31 percentage points, 95% CI 12-50; p = 0.002). Early vertebroplasty provided greater reductions in mean NRS pain and Roland-Morris Disability. CONCLUSION Analysis of this patient subgroup from the VAPOUR trial, in the context of other randomised trial evidence, suggests clinically significant benefits from early vertebroplasty if performed within 3 weeks of fracture. These slides can be retrieved from Electronic Supplementary Material.
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Affiliation(s)
- Terrence Diamond
- St George and Sutherland Clinical School UNSW, St George Hospital, Sydney, NSW, Australia.
| | - William Clark
- Interventional Radiology, St George Private Hospital, Sydney, NSW, Australia
| | - Paul Bird
- St George and Sutherland Clinical School UNSW, St George Hospital, Sydney, NSW, Australia
| | - Peter Gonski
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trial Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- NHMRC Clinical Trial Centre, University of Sydney, Sydney, NSW, Australia
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Wong SPY, Mok CC. Management of glucocorticoid-related osteoporotic vertebral fracture. Osteoporos Sarcopenia 2020; 6:1-7. [PMID: 32226826 PMCID: PMC7093682 DOI: 10.1016/j.afos.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/15/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
The vertebral column is the most common site of osteoporotic fractures in long-term users of glucocorticoids. Vertebral fracture leads to significant morbidities such as unrelenting pain, spinal deformities and reduced mobility, leading to diminished quality of life. Epidemiological data on the prevalence of glucocorticoid-induced vertebral fractures are limited. As vertebral fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews recent data on the prevalence of vertebral fractures in glucocorticoid users, fracture risk stratification, and evidence-based treatment options. The risk of osteoporotic fractures estimated by FRAX should be adjusted for glucocorticoid users. The first-line treatment of glucocorticoid-induced osteoporosis remains the bisphosphonates. Teriparatide and denosumab are alternative options. Percutaneous vertebroplasty and kyphoplasty may be considered for symptomatic control of acute vertebral fracture-related pain when conservative measures fail.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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50
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The Top 100 Most-Cited Articles on Kyphoplasty and Vertebroplasty. World Neurosurg 2020; 135:e435-e446. [DOI: 10.1016/j.wneu.2019.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/07/2023]
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