Vertebroplasty for vertebral fracture

In the linked meta-analysis of individual patient data (doi:10.1136/bmj.d3952), Staples and colleagues assess whether vertebroplasty for vertebral fracture is more effective than placebo in certain subgroups of people.1

Insufficiency fractures of the vertebra are a major cause of morbidity and are estimated to affect about one in four adults over the age of 50 years. Risk factors include age, low body mass index, smoking, alcohol misuse, family history, use of corticosteroids, and chronic illness. Although these associations may be used to predict the incidence of disease,2 this remains a substantial problem in later life, and preventive treatment has yet to reduce the incidence.

Medical interventions, such as lifestyle changes, hormone replacement, and bisphosphonates, have been used to treat vertebral fractures. However, it is unclear how best to manage the fracture, to alleviate pain, and to reduce long term disability. Since the original description of vertebroplasty in 1987,3 percutaneous cement augmentation has been widely advocated for pain management. Such procedures are normally performed on a day case basis and are undertaken using heavy sedation with fluoroscopy to guide an injection of cement into the fractured vertebra.

Many large unblinded trials have shown that cement augmentation results in a 70-90% improvement in symptoms within …