The treatment of spinal compression fractures has become big business. There are over 750,000 spinal compression fractures treated annually. 25% of adults will experience some sort of spinal compression fracture in their lifetime, and as of 2005 figures, $17 billion plus is spent treating these fractures on an annual basis.
So the question must be asked, why do we treat spinal compression fractures, and is there a cost benefit to this modality of treatment? Considering that baby boomers are not aging gracefully, it is estimated that within the next ten years 33% of the US population will be over 65 years of age. Osteoporosis is a disease of the aging. People with osteoporosis are quite susceptible to vertebral compression fractures. VCFx are very painful, and the possibility of long-term disability is a major concern. Over the years the treatment options have included, preventive medicine such as estrogen and calcium replacements, weight bearing exercises, analgesics, bracing, and surgical intervention.
Based on the AAOS guidelines and two Level II studies, quality of evidence was critical in supporting practice guidelines. It seems that they found that there was not enough of high quality evidence to support or oppose non-surgical and holistic treatments. Yet, they supported treating VCFx with signs and symptoms suggesting acute injury within 5 days of onset and the patient being neurologically intact with calcitonin. Calcitonin is indicated for elderly patients with low bone mass. The use of calcitonin may result in increased bone density particularly in the spine with a plateau effect in 18 months.
The AAOS made strong recommendations against the use of vertebroplasty in patients that are neurologically intact. The question must be asked, was there enough of data in these studies to substantiate their report? If these findings are inconsistent, why did they even bother to publish this information? It is difficult to comprehend the motivation of the AAOS. What we do know is that the ideal vertebral body for augmentation is one that has collapsed less than 50%. So the question must be asked was this a political ploy, or was this valid information?
If you experienced a VCFx wouldn't you want to Relieve the Pain, Restore Mobility and Resume Functioning? TSB wants to know what our readers think, and is there an underlying motivation behind the AAOS throwing this out into the public domain?