Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty

Abstract

We use vertebroplasty for patients with the most severe pain caused by osteoporotic vertebral fractures less than 6 weeks old, and have observed dramatic pain relief in this acute setting. A recent editorial in the Journal, written by the authors of two recent vertebroplasty trials, suggested that vertebroplasty is not an effective therapy for acute osteoporotic vertebral fractures. The trials described in the editorial sampled a very different patient cohort to the one that we treat with vertebroplasty. Our clinical experience and most of the published literature relating to the benefits of vertebroplasty are in striking contrast to the opinions presented in that editorial.

Two-Year Results of a Randomized Placebo-Controlled Trial of Vertebroplasty for Acute Osteoporotic Vertebral Fractures

“…Publication of our initial results together with the results of another placebo‐controlled trial that reported similar findings have generated considerable controversy, although most if not all of the proposed criticisms have been refuted . An unfounded criticism of our trial has been that it suffered from selection bias because 30% of potentially eligible participants declined to participate in the study.…”

Vertebroplasty for acute osteoporotic fractures – position statement from the Interventional Radiology Society of Australasia

“…Buchbinder refers to the two trials published together in NEJM as the ‘best available evidence for the efficacy of vertebroplasty’. These two trials do indeed provide high quality data – but not in the acute fracture group as has been previously suggested 5–7,17 . These two trials were not designed as acute fracture trials but enrolled patients with chronic back pain for up to 1 year.…”

“…It is interesting to note that this editorial was printed without any request for review by diagnostic or interventional radiology, and without consultation with IRSA. This is despite the significant concerns raised by numerous authors following publication of the results of these trials 5–7 . In addition, Buchbinder states that ‘in many settings, vertebroplasty has become the standard of care despite a lack of high level evidence to support this practice’.…”

Criticisms of the VAPOUR trial in a recent commentary are unsubstantiated and incorrect

“…The ‘highly selected’ study population reflects appropriate selection criteria 5. Enrolment differences between centres is similar to the previous, smaller trial4 except that, unlike that trial, VAPOUR met the required enrolment target specified in the study design.…”