Background: The heterogeneity of patients with osteoporotic vertebral compression
fractures (VCF) necessitates a tailored approach of balancing the benefits and limitations of
available treatments. Current guidelines are divergent, sometimes contradictory, and often
insufficiently detailed to guide practice decisions.
Objectives: This study aimed at establishing treatment recommendations at the patientspecific level.
Study Design: Using the RAND/UCLA Appropriateness Method (RAM), the appropriateness
of different treatment options for osteoporotic VCFs was assessed.
Setting: The assessment was conducted by a European multidisciplinary panel of 12 experts.
Methods: The appropriateness of non-surgical management (NSM), vertebroplasty (VP), and
balloon kyphoplasty (BKP) was determined for 128 hypothetical patient profiles. These were
unique combinations of clinical factors considered relevant to treatment choice (time since
fracture, MRI findings, impact and evolution of symptoms, spinal deformity, ongoing fracture
process, and pulmonary dysfunction). After 2 individual rating rounds and plenary meetings,
appropriateness statements (appropriate, inappropriate, and uncertain) were calculated for all
clinical scenarios.
Results: Disagreement dropped from 31% in the first round to 7% in the second round.
Appropriateness outcomes showed specific patterns for the 3 treatments. For three-quarters
of the profiles, only one treatment was considered appropriate: NSM 25%, VP 6%, and
BKP 45%. NSM was usually appropriate in patients with a negative MRI or a positive MRI
without other unfavorable conditions (poor outcomes for the other variables). VP was usually
appropriate in patients with a positive MRI, time since fracture ≥ 6 weeks, and no spinal
deformity. BKP was recommended for all patients with an ongoing fracture process, and also
in most patients with a positive MRI and ≥ 1 other unfavorable factor.
Limitations: The prevalence of the patient profiles in daily practice is yet unknown.
Conclusion: The panel results may help to support treatment choice in the heterogeneous
population of patients with osteoporotic VCF.
Key words: Appropriateness criteria, balloon kyphoplasty, non-surgical management,
osteoporosis, RAND/UCLA Appropriateness Method, treatment choice, vertebral compression
fractures, vertebroplasty:
Criteria for the Appropriate Treatment of
Osteoporotic Vertebral Compression Fractures