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| |  Vertebroplasty Pain Reduction Best When Optimal Medical Therapy Fails: Presented at SIR By Thomas R. Collins TAMPA, Fla -- March 16, 2010 -- Use of vertebroplasty to treat patients with osteoporosis works best when used after optimal medical treatment has failed and when interventional radiologists continue to work with rheumatologists on medical therapy after the procedure, according to an Italian study presented here at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting. Almost all of the patients in the study continued to have significantly lower scores on the visual analogue scale (VAS) for pain after an average of 31 months of follow-up, said Giovanni Anselmetti, MD, Institute for Cancer Research and Treatment, Turin, Italy. “We think the key to achieve the best result in vertebroplasty in osteoporosis is optimal patient selection and optimal medical treatment of osteoporosis,” Dr. Anselmetti said in a presentation on March 14. “We need to cooperate with the other physicians and not do everything by ourselves.” Osteoporosis affects 10 million Americans and is responsible for 700,000 fractures of the vertebrae each year, according to the society. Of the original cohort of 2,251 patients, 1,811 were women, and the average age was 65 years. The patients suffered from back pain from vertebral collapses, which were confirmed with magnetic resonance imaging. Vertebroplasty was performed in 1,542 of the patients when optimal medical treatment, including bisphosphonates, teriparatide, analgesics, and back braces, did not help relieve pain or improve quality of life over a 3-month period. The vertebroplasty group included 1,302 women, and the average age was 73 years. After vertebroplasty, patients continued to receive medical treatment with a rheumatologist. Significant back pain relief was achieved in 1,494 patients (97%). Among those, the VAS score dropped from an average of 8.2 to 1.1 during the period shortly after the procedure. On the Oswestry Disability Questionnaire, which measures ability to wash, dress, and stand and other quality-of-life indicators, scores improved significantly, falling from an average of 68.7 to 18.5. The patients with long-term follow-up, averaging 31.2 months, had a drop in average VAS score from 7.9 to 1.3. “The results last during long-term follow-up,” Dr. Anselmetti said. He said there is a need for a randomised trial comparing conventional treatment with a combination of vertebroplasty and medical treatment, but he acknowledged that might be difficult. “It’s very difficult in Italy and in some other countries in Europe to make a randomised trial, because no patients want to be randomised -- they want to be treated.” [Presentation title: Percutaneous Vertebroplasty (PV) in the Osteoporotic Patient: Optimal Indications and Patient Selection to Improve Clinical Outcome: Personal Experience in 1,542 Patients Over Seven Years Experience. Abstract 16]
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