[show abstract][hide abstract] ABSTRACT: Vertebral compression fractures (VCFs) are the most prevalent fractures in osteoporotic patients. The classical conservative
management of these fractures is through rest, pain medication, bracing and muscle relaxants. The aim of this paper is to
review prospective controlled studies comparing the efficacy and safety of minimally invasive techniques for vertebral augmentation,
vertebroplasty (VP) and balloon kyphoplasty (BKP), versus non-surgical management (NSM). The Fracture Working Group of the
International Osteoporosis Foundation conducted a literature search and developed a review paper on VP and BKP. The results
presented for the direct management of osteoporotic VCFs focused on clinical outcomes of these three different procedures,
including reduction in pain, improvement of function and mobility, vertebral height restoration and decrease in spinal curvature
(kyphosis). Overall, VP and BKP are generally safe procedures that provide quicker pain relief, mobility recovery and in some
cases vertebral height restoration than conventional conservative medical treatment, at least in the short term. However,
the long-term benefits and safety in terms of risk of subsequent vertebral fractures have not been clearly demonstrated and
further prospective randomized studies are needed with standards for reporting. Referral physicians should be aware of VP/BKP
and their potential to reduce the health impairment of patients with VCFs. However, VP and BKP are not substitutes for appropriate
evaluation and treatment of osteoporosis to reduce the risk of future fractures.
KeywordsIOF–Kyphoplasty–Osteoporosis–Pain management–Vertebral fractures–Vertebroplasty
Osteoporosis International 04/2012; 22(12):2915-2934. · 4.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper reviews the evidence for an association between atypical subtrochanteric fractures and long-term bisphosphonate use. Clinical case reports/reviews and case-control studies report this association, but retrospective phase III trial analyses show no increased risk. Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is yet unproven.
A Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the International Osteoporosis Foundation has reviewed the evidence for a causal association between subtrochanteric fractures and long-term treatment with bisphosphonates, with the aim of identifying areas for further research and providing recommendations for physicians.
A PubMed search of literature from 1994 to May 2010 was performed using key search terms, and articles pertinent to subtrochanteric fractures following bisphosphonate use were analysed.
Several clinical case reports and case reviews report a possible association between atypical fractures at the subtrochanteric region of the femur in bisphosphonate-treated patients. Common features of these 'atypical' fractures include prodromal pain, occurrence with minimal/no trauma, a thickened diaphyseal cortex and transverse fracture pattern. Some small case-control studies report the same association, but a large register-based study and retrospective analyses of phase III trials of bisphosphonates do not show an increased risk of subtrochanteric fractures with bisphosphonate use. The number of atypical subtrochanteric fractures in association with bisphosphonates is an estimated one per 1,000 per year. It is recommended that physicians remain vigilant in assessing their patients treated with bisphosphonates for the treatment or prevention of osteoporosis and advise patients of the potential risks.
Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is unproven and requires further research. Were the case to be proven, the risk-benefit ratio still remains favourable for use of bisphosphonates to prevent fractures.
Osteoporosis International 11/2010; 22(2):373-90. · 4.04 Impact Factor