Saturday, November 2, 2001 4:13–4:56 pm Concurrent Session 8B: Metabolic/Vertebroplasty: 4:13 Steroid-induced secondary osteoporosis: relationship to subsequent compression fractures after kyphoplasty

Abstract

Purpose of study: Vertebral column osteoporotic compression fractures is a major medical concern in the elderly population. Vertebral augmentation with methyl methacrylate, either kyphoplasty or vertebroplasty, has been shown to correlate with improved outcome in the short term, but the long-term results are unknown. A retrospective review was performed to analyze the short-term results after kyphoplasty in terms of remote and adjacent-level fractures in osteoporotic patients and in particular the relationship of long-term steroid use to subsequent compression fractures.Methods used: A total of 175 patients treated for osteoporotic compression fractures at the Cleveland Clinic, from October 1999 to November 2002 were identified, and 60 patients were excluded because of insufficient follow-up, less than 3 months, or malignancy-related fractures. The remaining 115 patients' office charts, hospital records, prospective database information, operative reports and radiographs were then individually analyzed. New fractures were identified based on changes from baseline imaging studies. Adjacent fractures were defined as a new, occurring after initial kyphoplasty, compression fracture in the vertebral body immediately rostral or caudal to a body treated with kyphoplasty and confirmed with methyl methacrylate on imaging studies. Remote fractures were defined as a new fracture with at least one vertebral body between the new fracture and the prior treated compression fracture. Demographic information, vertebral levels treated, number of two- and three-level adjacent kyphoplasties, time of follow-up, adjacent fractures, remote fractures and chronic steroid medication were entered into the database, and statistical analysis (p<.05) was performed.of findings: A total of 225 levels were treated with kyphoplasty in the 115 patients included in analysis. Follow-up ranged from 3 to 26 months with a mean of 10 months. There were 80 patients with primary osteoporosis and 35 patients with secondary osteoporosis resulting from long-term steroid medications. These populations were similar in terms of demographics, single, two or multiple sites, along with two or three adjacent levels treated. Twenty-two patients sustained postkyphoplasty compression fractures of which 15 patients were on chronic steroid medication. Although only 7 patients with primary osteoporosis developed a new compression fracture, this increased fracture rate in the steroid patients was highly significant (p<.0001), along with analysis of adjacent fractures (11 of 17 on steroids, p=.0009), and remote fractures (5 of 7 on steroids (p=.0265).Relationship between findings and existing knowledge: No data exist about the incidence of postkyphoplasty compression fractures.Overall significance of findings: This study clearly illustrates the increased incidence of compression fractures after kyphoplasty in the steroid-dependent population.Disclosures: Device or drug: kyphon balloon tamp. Status: approved.Conflict of interest: No conflicts.