Symptomatic refractures after vertebroplasty in patients with steroid-induced osteoporosis

Abstract

Background and purpose: Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis.

Methods: A retrospective analysis was performed on all osteoporosis patients having initial vertebroplasty from August 1999 to August 2003. The follow-up period was limited to 1 year after initial vertebroplasty session, with the last follow-up date ending in August 2004. Data were collected on 387 osteoporosis patients.

Results: Of the patients with primary osteoporosis, 20.6% patients refractured whereas 37.8% of the patients with steroid-induced osteoporosis had symptomatic refractures within 1 year of initial vertebroplasty. Relative risk of refracture within 1 year for the patients with steroid-induced osteoporosis was 1.84 compared with the patients with primary osteoporosis. In addition, the patients with steroid-induced osteoporosis were more likely to refracture after their second treatment session (within 1 year of initial vertebroplasty) than those with primary osteoporosis.

Conclusion: Patients presenting on oral steroid therapy at their initial vertebroplasty are almost twice more likely to have symptomatic refractures than primary osteoporosis patients within 1 year of initial vertebroplasty.

Fig 1.

Example of patient with steroid-induced osteoporosis. Lateral thoracic spine plain-film radiograph. Initial prevertebroplasty film demonstrates T6 compression fracture.

Fig 2.

Follow-up of the same patient. Lateral thoracic spine plain-film radiograph. One-year follow-up film demonstrates that the patient has undergone vertebroplasties of T5 through T8 and presents with a new fracture of T10 at the time of the study.

Fig 3.

Primary and steroid-induced osteoporotic symptomatic refracture rates comparing 1-year follow-up with an extended follow-up

Fig 4.

Graphs demonstrating relative frequencies of prevalent and incident fractures in both the steroid and osteoporosis groups.