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Vertebroplasty for Patients With Osteoporosis Provides Effective Pain Relief

Vertebroplasty for Patients With Osteoporosis Provides Effective Pain Relief. G.C. Anselmetti , A. Manca, G. Chiara, G. Iussich, G. Isaia * and D. Regge. Interventional Radiology IRCC Candiolo (Turin) - ITALY *Metabolic Bone Disease, University of Turin, Turin,- ITALY. No Disclosure.

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Vertebroplasty for Patients With Osteoporosis Provides Effective Pain Relief

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  1. Vertebroplasty for Patients With Osteoporosis Provides Effective Pain Relief G.C. Anselmetti, A. Manca, G. Chiara, G. Iussich, G. Isaia* and D. Regge Interventional Radiology IRCC Candiolo (Turin) - ITALY *Metabolic Bone Disease, University of Turin, Turin,- ITALY No Disclosure

  2. Patients Pre-Procedural Evaluation • Since 2002, 2251 osteoporotic pts (1811 female, mean age 65,4±10,7 yrs), suffering from back-pain for vertebral collapses, underwent clinical interview in our Institute. • All patients had 1 or more vertebral fracture at MRI • Clinical palpation of fractured vertebrae evocated pain in 1860 (82,6%) • 842 (45,3%) had pain duration <1 month • Only 661 /2251 (29,4%) had previous medical treatment for osteoporosis by a qualified rheumatologist!

  3. Patients’ Selection After optimal medical treatment was applied, (from 1,5 to 3 months), 709/2251 (31,5%) reported back-pain regression and scheduled PV was not performed • 1542 pts (1302 female, mean age 73,5±9,8 yrs), not improved by medical therapy and with collapsed vertebrae at MRI (1204 with bone marrow edema), underwent to PV • Optimal medical therapy for osteoporosis was continued in all pts by rheumatologist after PV

  4. Patient’s Selection 80 years old Osteoporotic Woman MR showed a painful fracture of L3 and L4 at first clinical interview. Patient was never cured for osteoporosis before MR January 2009

  5. Patient’s Selection 80 years old Osteoporotic Woman After 3 months course of optimal medical therapy by rheumatologist, patient was still in pain. MR detected new fractures of L1 and L2PV was successfully performed with complete pain relief MR April 2009 Vertebroplasty

  6. Early Results(Follow-up 3 months) Short-term follow-up prospectively evaluated pain with Visual Analog Scale(VAS - 0=no pain to 10=worst experienced pain)and Oswestry Disability Index (ODI): 1542 pts (1302 female, mean age 73)

  7. Early Results(3 months follow-up) PV was completed in all 1542 patients without major complications 1494/1542patients(96,9%)reported backpain relief • VASfrom 8,2±1,8 to 1,1±1,6 (p<.0005 Wilcoxon signed test) • ODIfrom 68,7±7,6% to 18,5±8,2% (p<.0005 t-test)

  8. Long-term Results - 1017 pts(Follow-up 72-18 months, mean 31,2±13,3) Long-term follow-up prospectively evaluated pain with Visual Analog Scale (VAS - 0=no pain to 10=worst experienced pain), analgesic drug assumption, external brace support and new vertebral fracture occurrence in: 1017 pts (857 female, mean age 72±10,3 yrs) All pts underwentoptimal medical therapyfor osteoporosis by experienced rheumatologists

  9. Long-termVAS- 1017 pts(Follow-up 72-18 months, mean 31,2±13,3) mean VAS of7,9±1,5significantly droppedto1,3±1,7 (p<0.0001 Wilcoxon signed test)

  10. Long-termDrugs assumption - 1017 pts(Follow-up 72-18 months, mean 31,2±13,3) NSAIDs: non-steroidal anti-inflammatory drugs 830(81.6%) of 1017 patientsdid not need any medicationafter PV and 171 (16.8%) use only NSAIDs

  11. Long-termBrace Support - 1017 pts(Follow-up 72-18 months, mean 31,2±13,3) among 757 pts wearing a brace before PV,683(90.2%) could avoid it after PV (χ2=680.01, p<.0001)

  12. Long-termNew Fractures - 1017 pts(Follow-up 72-18 months, mean 31,2±13,3) 124/1017(12,2%)reported a new painful vertebral fracture during follow-up

  13. New Fracture during 18 months Follow-upAmong 1017 patients,606 women(age over 65, 1 or more prevalent fractures at PV and follow-up equal or longer than 18 months), with the same demographic characteristics as the patients reported by Lindsay and coworkersPVP vs. Placebo & Teriparatide No significant differencewas noticed for both low doses (20G Teriparatide) and high doses (40G Teriparatide) therapy

  14. Conclusions • This large series shows that PV iseffectivein treatment ofchronic back-paindue toosteoporotic vertebral collapseswhereas optimal medical therapy (lasting from 1 to 3 months) fails. • It should be evident that PV cures vertebral fractures only, not osteoporosis and it can not prevent new fracture occurrence. • To achieve the best clinical outcome: • optimal pts selection • correct indications • optimal medical treatment of osteoporosis • are mandatory

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