Effect of Preoperative Zoledronic Acid Administration on Pain Intensity after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Introduction. This study aimed to compare and analyze the effect of preoperative zoledronic acid (ZOL) administration on pain intensity after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods. The study included 242 patients with OVCFs who underwent PVP in our hospital between January 2015 and June 2018. The patients were randomly assigned to either a ZOL group (n = 121) or a control group (n = 121). The patients in the ZOL group were treated preoperatively with intravenous infusion of 5 mg ZOL. Those in the control group were treated without ZOL. All the patients were followed up for 1 year. Results. No statistically significant differences in age, sex, weight, and body mass index (BMI) were found between the two groups. During the follow-up period, the visual analog scale score and Oswestry dysfunction index score in the ZOL group were lower than those in the control group. The bone mineral density at 6 or 12 months after treatment was significantly higher and the levels of the bone metabolism markers were significantly lower in the ZOL group than in the control group (P<0.05 for both). Two patients in the treatment group had new vertebral fractures, whereas 13 patients in the control group had new vertebral fractures, which translate to recompression vertebral fracture incidence rates of 1.7% and 10.7%, respectively. The incidence rate of mild adverse reactions was significantly higher in the ZOL group than in the control group, but all the cases were endurable. Conclusion. Intravenous infusion of ZOL before PVP can effectively reduce postoperative pain intensity, reduce bone loss, increase bone density, reduce the risk of refracture, and improve patient quality of life.

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Effects of rosuvastatin and zoledronic acid in combination on the recovery of senile osteoporotic vertebral compression fracture following percutaneous vertebroplasty

Journal of International Medical Research ◽

10.1177/0300060520925390 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092539 ◽

Cited By ~ 1

Author(s):

Hong Li ◽

Yu Wang ◽

Rui Wang ◽

Lei Yue ◽

Shunlun Chen ◽

...

Keyword(s):

Zoledronic Acid ◽

Bone Density ◽

Vertebral Compression Fracture ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Post Treatment ◽

Control Group ◽

Type I ◽

Observation Group

Objectives This study analyzed the effects of rosuvastatin and zoledronic acid in combination on patient recovery following percutaneous vertebroplasty (PVP) that was performed to treat senile osteoporotic vertebral compression. Methods Senile patients with osteoporotic vertebral compression fracture (n = 120) were included in this retrospective study, and they were classified into two groups. Those in the control group (n = 60) were treated with PVP + caltrate and those in the observation group (n = 60) received this treatment with combined zoledronic acid and rosuvastatin. Between-group comparisons were made at both pre- and post-treatment regarding bone density, type I procollagen peptide (CTX) and bone-specific alkaline phosphatase (BAP) levels, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and adjacent centrum refracture. Results Bone density was higher and BAP and CTX levels as well as ODI and VAS scores were lower at post-treatment in the observation group compared with the control group. The refracture rate in the observation group was lower compared with the control group. Conclusion Treatment with a combination of rosuvastatin and zoledronic acid following PVP can improve the condition of senile osteoporotic vertebral compression fracture and patient’s functional status, and it can also alleviate pain.

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Effects of once-yearly zoledronic acid on bone density and incident vertebral fractures in nonmetastatic castration-sensitive prostate cancer patients with osteoporosis

BMC Cancer ◽

10.1186/s12885-021-08177-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daisuke Watanabe ◽

Takahiro Kimura ◽

Ken Watanabe ◽

Hiromitsu Takano ◽

Yuko Uehara ◽

...

Keyword(s):

Prostate Cancer ◽

Zoledronic Acid ◽

Vertebral Fractures ◽

Rate Of Change ◽

Therapeutic Interventions ◽

Control Group ◽

Mineral Density ◽

Tracp 5B ◽

Future Fracture ◽

Incident Vertebral Fractures

Abstract Background Androgen deprivation therapy (ADT) is the effective treating prostate cancer but is often accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient’s quality of life. In patients with nonmetastatic castration-sensitive prostate cancer (M0CSPC) who already have osteoporosis before starting ADT, appropriate bone-modifying agent intervention must be performed in parallel, as the patient has a high risk of future fracture. However, little is known about therapeutic interventions aimed at preventing the progression of CTIBL and new fractures. The present study explored the effect of once-yearly zoledronic acid 5 mg (ZOL 5 mg) on bone mineral density (BMD) and new vertebral fractures (VFs) in M0CSPC patients with coexisting osteoporosis before starting ADT. Methods We conducted a retrospective, multi-institutional, cohort study involving 42 M0CSPC patients with osteoporosis who had undergone ADT with/without a single intravenous infusion of ZOL 5 mg at the start of ADT (ZOL 5 mg group, n = 26; control group, n = 16). The association of the ZOL 5 mg with changes in the BMD from baseline to 12 months and the incidence of VFs were evaluated. Results Prevalent VFs were found in 47.6% of all patients at baseline. ZOL 5 mg significantly increased the lumbar spine BMD (LS-BMD) (mean rate of change: + 4.02%, p < 0.0001) and significantly decreased the TRACP-5b (mean rate of change: − 52.1%, p < 0.0001) at 12 months after starting ADT. Incident VFs were identified in 19.0% of all patients at 12 months after starting ADT. After adjusting for the age, BMI, and changes in the LS-BMD, ZOL 5 mg was not significantly associated with incident VFs (odds ratio 0.66, 95% confidence interval 0.04–11.3, p = 0.7774). Conclusion ZOL 5 mg significantly increased the LS-BMD 12 months after starting ADT, and our short-term results showed that ZOL 5 mg was not significantly correlated with the suppression of incident vertebral fractures.

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Establishment and validation of a nomogram and web calculator for the risk of new vertebral compression fractures and cement leakage after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures

European Spine Journal ◽

10.1007/s00586-021-07064-z ◽

2021 ◽

Author(s):

Wenle Li ◽

Haosheng Wang ◽

Shengtao Dong ◽

Zhi-Ri Tang ◽

Longhao Chen ◽

...

Keyword(s):

Risk Factors ◽

Vertebral Fractures ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Vertebral Compression Fractures ◽

Mineral Density ◽

Clinical Value ◽

Compression Fractures ◽

Multiple Vertebral Fractures ◽

New Onset

Abstract Purpose The aim of this work was to investigate the risk factors for cement leakage and new-onset OVCF after Percutaneous vertebroplasty (PVP) and to develop and validate a clinical prediction model (Nomogram). Methods Patients with Osteoporotic VCF (OVCF) treated with PVP at Liuzhou People’s Hospital from June 2016 to June 2018 were reviewed and met the inclusion criteria. Relevant data affecting bone cement leakage and new onset of OVCF were collected. Predictors were screened using univariate and multi-factor logistic analysis to construct Nomogram and web calculators. The consistency of the prediction models was assessed using calibration plots, and their predictive power was assessed by tenfold cross-validation. Clinical value was assessed using Decision curve analysis (DCA) and clinical impact plots. Results Higher BMI was associated with lower bone mineral density (BMD). Higher BMI, lower BMD, multiple vertebral fractures, no previous anti-osteoporosis treatment, and steroid use were independent risk factors for new vertebral fractures. Cement injection volume, time to surgery, and multiple vertebral fractures were risk factors for cement leakage after PVP. The development and validation of the Nomogram also demonstrated the predictive ability and clinical value of the model. Conclusions The established Nomogram and web calculator (https://dr-lee.shinyapps.io/RefractureApp/) (https://dr-lee.shinyapps.io/LeakageApp/) can effectively predict the occurrence of cement leakage and new OVCF after PVP.

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Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02722-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wei Mao ◽

Fei Dong ◽

Guowei Huang ◽

Peiliang He ◽

Huan Chen ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Secondary Fracture ◽

Compression Fractures ◽

Secondary Fractures ◽

At Home

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. Methods The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. Results A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. Conclusion The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.

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Cortical Bone Trajectory Instrumentation with Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture

Medicina ◽

10.3390/medicina56020082 ◽

2020 ◽

Vol 56 (2) ◽

pp. 82

Author(s):

Wei-Lin Hsu ◽

Yu-Hsiang Lin ◽

Hao-Yu Chuang ◽

Han-Chung Lee ◽

Der-Cherng Chen ◽

...

Keyword(s):

Cortical Bone ◽

Vertebral Fractures ◽

Percutaneous Vertebroplasty ◽

Screw Fixation ◽

Pedicle Screws ◽

Vertebral Compression Fractures ◽

Thoracolumbar Fractures ◽

Mineral Density ◽

Cortical Bone Trajectory ◽

Post Surgery

Background: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes. Method: We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months. Result: The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was −3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up. Conclusions: Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.

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UNILATERAL PERCUTANEOUS VERTEBROPLASTY FOR SYMPTOMATIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES -EVALUATION OF RADIOLOGICAL AND CLINICAL OUTCOMES

10.36106/ijsr/1033481 ◽

2021 ◽

pp. 1-2

Author(s):

Sandeep Kumar ◽

Kumari Rashmi ◽

Kumar Anshuman ◽

Debarshi Jana

Keyword(s):

Vertebral Fractures ◽

Local Anaesthesia ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Early Mobilization ◽

Vertebral Compression Fractures ◽

Vas Score ◽

Osteoporotic Vertebral Fractures

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia. Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between August 2019 and July 2020 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up. Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17. The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001). Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.

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Unilateral percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fractures -evaluation of radiological and clinical outcomes

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185328 ◽

2018 ◽

Vol 5 (1) ◽

pp. 19

Author(s):

Shanmuga Sundaram Pooswamy ◽

Niranjanan Raghavn Muralidharagopalan

Keyword(s):

Vertebral Fractures ◽

Local Anaesthesia ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Early Mobilization ◽

Vertebral Compression Fractures ◽

Vas Score ◽

Osteoporotic Vertebral Fractures

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia.Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between 2012 and 2015 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up.Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17. The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001).Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.

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Effectiveness Analysis of Percutaneous Kyphoplasty Combined with Zoledronic Acid in Treatment of Primary Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.63 ◽

2019 ◽

Vol 1 (22;1) ◽

pp. 63-68

Author(s):

Shao-Xiong Xiao

Keyword(s):

Bone Mineral Density ◽

Zoledronic Acid ◽

Treatment Group ◽

Vertebral Compression Fractures ◽

Control Group ◽

P Value ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Compression Fractures

Objective: To investigate the therapeutic effectiveness of percutaneous kyphoplasty (PKP) combined with zoledronic acid in treatment of primary osteoporotic vertebral compression fractures. Study Design: A perspective cohort study was conducted at a single institution for patients, who received PKP operation due to primary osteoporotic vertebral compression fracture between January 2014 and January 2015. Setting: According to whether they received postoperative zoledronic acid or not, patients were divided into treatment or control groups, with 30 randomly-selected cases per group. Methods: The visual analogue scale (VAS), which was used to assess the degree of pain, and the bone mineral density, was analyzed at 1-, 6-, and 12-month follow-ups. Results: In general, patients experienced marked pain relief after surgery. No significant difference in pain relief was observed in the control group between the 6 and 12-month followup. In contrast, the VAS score of the treatment group at 12-month follow-up was significantly lower than that at 6-month (P value = 0.03). Moreover, it was also significantly lower than the VAS score in the control group at the 12-month follow-up (P value = 0.0018). The bone mineral density of patients from the treatment group increased significantly and progressively after the surgery (pre-operation versus 6-month follow-up: P value = 0.01; 6-month versus 12-month follow-up: P value < 0.001), and it was also remarkably higher than that of the control group at the 12-month follow-up (P value < 0.0001). Limitations: Patients were collected from a single hospital. The maximum postoperative followup time was 12 months. The sample size was relatively small. Thus, bias could occur in the selection of cases if they are not representative of the population. Conclusion: The combined treatment of zoledronic acid with PKP for primary osteoporotic vertebral compression fractures safely and effectively relieved low back pain, significantly increased bone density, and improved the quality of life. The clinical effectiveness is promising and worthy of further study. Key words: Kyphoplasty, zoledronic acid, primary osteoporotic vertebral compression fractures

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Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02573-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ji Guo ◽

Weifeng Zhai ◽

Licheng Wei ◽

Jianpo Zhang ◽

Lang Jin ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Vertebral Fractures ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Balloon Kyphoplasty ◽

Cement Leakage ◽

Osteoporotic Vertebral Compression Fracture ◽

Control Group ◽

Compression Rate ◽

Kyphotic Angle

Abstract Background This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA. Methods Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP. Results KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures. Conclusions OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use. Trial registration Retrospectively registered.

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Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Journal of International Medical Research ◽

10.1177/0300060521989468 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052198946

Author(s):

Xiaoguang Fan ◽

Sha Li ◽

Xianshang Zeng ◽

Weiguang Yu ◽

Xiangzhen Liu

Keyword(s):

Risk Factors ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Mineral Density ◽

Eligibility Criteria ◽

Compression Fractures ◽

Logistic Analysis ◽

The Difference ◽

Poor Outcomes

Objective To explore possible risk factors for poor outcomes following percutaneous vertebroplasty (PV) for painful osteoporotic compression fractures of thoracolumbar vertebra. Methods This was a retrospective review of data from patients who underwent PV at our institution over a ten-year period to evaluate the association between possible risk factors and thoracolumbar pain (T11-L2). According to the difference between pre- and post-operative visual analogue scale (VAS) scores for pain, patients were separated into poor relief (PR; <4) and good relief (GR; ≥4) of pain. Results Of the 750 patients identified, 630 (PR group, n =310; GR group, n = 320) fulfilled the eligibility criteria. Multivariate binary logistic analysis showed that bone mineral density (BMD), >2 fractured vertebral bodies, maldistribution of bone cement, <5 ml bone cement injected into a single vertebral body and thoracolumbar fascia injury prior to surgery were independent risk factors associated with thoracolumbar pain following PV. Conclusion Although prospective controlled studies are required to confirm our results, this review suggests that the above factors should be taken into account when selecting patients for PV.

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