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European Spine Journal : Official... Apr 2024Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty... (Review)
Review
BACKGROUND
Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are employed to treat those who remain symptomatic, with comparable clinical outcomes. Although PVP is faster and less expensive, concerns around cement-leakage complications make PKP perceptively safer.
METHODS
By means of systematic review, we sought to ascertain whether PVP did carry a higher risk of cement-leakage and associated symptomatic complications (neural compromise, pulmonary embolism and need for emergency decompression surgery).
RESULTS
Our search of 138 articles returned six studies after shortlisting and manual review: three randomised-controlled trials, and three retrospective comparative studies which met our criteria and directly compared cement-leakage rates and complications between the two treatments. 532 PVPs and 493 PKPs recorded 213 (39.3%) and 143 (28.9%) leaks, respectively (p < 0.0005). Of these, no leaks resulted in any of the aforementioned leak-related complications. No meta-analysis was performed due to heterogeneity of the data.
CONCLUSIONS
We therefore concluded that whilst PVP does result in more cement leaks, this does not appear to be clinically significant. Further studies would add weight to this conclusion, and cost-effectiveness should be assessed to restore confidence in PVP.
LEVEL OF EVIDENCE
Level III Evidence.
Topics: Humans; Aged; Kyphoplasty; Fractures, Compression; Retrospective Studies; Clinical Relevance; Spinal Fractures; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Bone Cements
PubMed: 37999769
DOI: 10.1007/s00586-023-08026-3 -
Medicine Nov 2023To investigate the effect of Vertebral augmentation (VA) in the treatment of single-level osteoporotic vertebral compression fractures (OVCFs) on new vertebral fractures. (Meta-Analysis)
Meta-Analysis
The risk of new vertebral fracture after percutaneous vertebral augmentation in patients suffering from single-level osteoporotic vertebral compression fractures: A meta-analysis and systematic review.
BACKGROUND
To investigate the effect of Vertebral augmentation (VA) in the treatment of single-level osteoporotic vertebral compression fractures (OVCFs) on new vertebral fractures.
METHODS
Electronic databases Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were searched from database creation to 5 September 2022. Eligible studies had to use VA as an intervention and conservative treatment as a control group. Studies had to explicitly report whether new vertebral fractures occurred during follow-up. Data were extracted by multiple investigators. Data were pooled using random or fixed effects models depending on the degree of heterogeneity.
RESULTS
Of the 682 articles screened, 7 met the inclusion criteria and were included in the analysis, giving a total of 1240 patients. Meta-analysis showed that VA (OR = 2.10, 95% CI: 1.35-3.28, P = .001) increased the risk of new postoperative vertebral fractures compared with conservative treatment. Subgroup analyses showed that the risk was greater in the group with a follow-up time greater than 1 year (OR = 2.57, 95% CI: 1.06-6.26, P = .001). Compared with conservative treatment, VA (OR = 2.17, 95% CI: 1.23-3.82, P = .007) increased the risk of postoperative adjacent vertebral fracture.
CONCLUSION SUBSECTIONS
VA is associated with an increased risk of new vertebral fractures and adjacent vertebral fractures following single-level OVCFs. With longer follow-ups, new vertebral fractures may be more significant. Clinical surgeons should pay attention to long-term postoperative complications and choose treatment carefully.
Topics: Humans; Spinal Fractures; Fractures, Compression; Kyphoplasty; Vertebroplasty; Osteoporotic Fractures; Treatment Outcome
PubMed: 37986316
DOI: 10.1097/MD.0000000000035749 -
Maturitas Jan 2024Nocebo is a concept of therapeutics referring to unpleasant symptoms attributed by a patient to a drug, due to negative anticipation. Patients receiving oral... (Meta-Analysis)
Meta-Analysis Review
Nocebo-associated treatment discontinuation with subcutaneous anti-osteoporotic drugs. A systematic review and meta-analysis of placebo-arm dropouts in randomized-controlled trials.
OBJECTIVE
Nocebo is a concept of therapeutics referring to unpleasant symptoms attributed by a patient to a drug, due to negative anticipation. Patients receiving oral anti-osteoporotic drugs in randomized controlled trials (RCT) can experience adverse events leading to dropout, implying that nocebo contributes to treatment discontinuation for these drugs. In this study we aim to investigate the nocebo effect of subcutaneous anti-osteoporotic drugs with a higher compliance rate than orally administered drugs.
STUDY DESIGN
We searched MEDLINE, EMBASE, SCOPUS, and Cochrane databases for double-blind trials investigating subcutaneous anti-osteoporotic drugs for osteoporosis (namely, denosumab, teriparatide, abaloparatide and romosozumab) published up to May 2023.
MAIN OUTCOME MEASURE
Dropouts due to reported adverse events in the placebo arms ("nocebo dropouts").
RESULTS
Data from 17 trials were extracted. Among 10,529 placebo-treated patients the pooled nocebo-dropout percentage was 3 % for denosumab (average: 0.03; 95 % CI: 0.01-0.05), 1 % for romosozumab (average: 0.01; 95 % CI: 0.00-0.03) and 6 % for teriparatide and abaloparatide (average: 0.06; 95 % CI: 0.05-0.07). Nocebo-dropouts were significantly higher in men than women (6 % vs. 3 %, respectively, p = 0.012), in older (mean age >68 years) than in younger patients (5 % vs. 1 %, respectively, p = 0.017) and in those with more severe osteoporosis (based on the percentage of participants with prior fragility-related fractures in the study cohort) compared with patients with no prior fracture history (4 % vs. 1 %, respectively, p = 0.046).
CONCLUSION
Nocebo responses may contribute to treatment discontinuation with subcutaneous anti-osteoporotic drugs in clinical practice. Higher nocebo-related dropout rates in the higher-risk RCT population (older patients, males, those with prior fractures) show that nocebo mechanisms have the potential to hinder therapeutic efforts to specific populations who would benefit most. Prospero registration number CRD42020212843.
Topics: Male; Female; Humans; Aged; Teriparatide; Nocebo Effect; Denosumab; Osteoporosis; Fractures, Bone; Bone Density Conservation Agents; Randomized Controlled Trials as Topic
PubMed: 37976923
DOI: 10.1016/j.maturitas.2023.107874 -
Osteoporosis International : a Journal... Mar 2024The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it....
UNLABELLED
The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk.
PURPOSE
The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients' preferences regarding fracture risk communication.
METHODS
To assess patients' preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture.
RESULTS
A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk.
CONCLUSIONS
There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.
Topics: Humans; Female; Middle Aged; Aged; Patient Preference; Pilot Projects; Risk Assessment; Canada; Osteoporosis; Osteoporotic Fractures; Communication; Risk Factors
PubMed: 37955683
DOI: 10.1007/s00198-023-06955-9 -
Experimental and Therapeutic Medicine Dec 2023The present study collected retrospective research data and compared the safety and efficacy of unilateral and bilateral percutaneous puncture kyphoplasty for the...
Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture: A meta‑analysis and systematic review.
The present study collected retrospective research data and compared the safety and efficacy of unilateral and bilateral percutaneous puncture kyphoplasty for the treatment of vertebral fractures caused by osteoporosis, to guide the selection of clinical surgical methods. In the present meta-analysis, PubMed, Embase and the Cochrane Library were searched from the establishment of the databases to March 2023. Studies that reported differences in the efficacy and safety between the unilateral and bilateral approaches in the treatment of osteoporotic vertebral compression fractures were included in the analysis. Duplicate published studies, unpublished studies, studies with incomplete data, animal experiments, literature reviews and systematic studies were excluded from the analysis. All data were processed using STATA 15.1 statistical software. The pooled results demonstrated that there were no significant differences between the unilateral and bilateral approaches in the visual analog scores, Oswestry disability index, height restoration rate or incidence of cement leakage. However, the post-kyphotic angle of the unilateral approach was significantly lower than that of the bilateral approach (standardized mean difference, -0.41; 95% confidence interval, -0.68 to -0.14; P=0.003). Furthermore, the pooled results demonstrated that the unilateral approach required less operative time and a lower volume of injected cement, which is safer for elderly patients who are more likely to have underlying diseases.
PubMed: 37941587
DOI: 10.3892/etm.2023.12252 -
Sleep Medicine Reviews Feb 2024We reviewed and meta-analyzed 20 observational studies to examine the relationship between sedative-hypnotic use and osteoporotic fractures. We searched PubMed, Embase,... (Meta-Analysis)
Meta-Analysis Review
We reviewed and meta-analyzed 20 observational studies to examine the relationship between sedative-hypnotic use and osteoporotic fractures. We searched PubMed, Embase, APA PsycINFO, and Web of Science™ for studies that used cohort, case-control, case-crossover, and self-controlled case series designs. We further assessed the quality of each study and performed meta-analyses of association estimates, e.g., odds ratios (ORs). The analysis included 6,084,083 participants and found a slight association between the use of sedative-hypnotics and osteoporotic fractures, with differing strength of associations between different classes of drugs and greater sedative-hypnotics exposure. The pooled estimates ORs for case-control studies were 1.33 (95% CI 0.98-1.80) with benzodiazepines (BZD) and any fractures, 1.32 (95% CI 1.05-1.66) with BZDs and hip fractures, and case-crossover studies were 1.15 (95% CI 0.95-1.41) with BZDs and any fractures, 1.41 (95% CI 1.08-1.85) with Z-drugs and any fractures. The study suggests that more research is needed to aid medical professionals in balancing this potential risk of osteoporotic fractures associated with sedative-hypnotic use against other reported adverse events and anticipated therapy outcomes.
Topics: Humans; Benzodiazepines; Case-Control Studies; Hypnotics and Sedatives; Osteoporotic Fractures
PubMed: 37926010
DOI: 10.1016/j.smrv.2023.101866 -
Journal of Endocrinological... Apr 2024Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent... (Review)
Review
PURPOSE
Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF.
METHODS
We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage.
RESULTS
Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF.
CONCLUSION
The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.
Topics: Humans; Randomized Controlled Trials as Topic; Spinal Fractures; Fractures, Bone; Spine; Osteoporotic Fractures
PubMed: 37921990
DOI: 10.1007/s40618-023-02222-0 -
World Neurosurgery Jan 2024Percutaneous curved vertebroplasty (PCVP), a modified traditional unilateral percutaneous vertebroplasty (UPVP) technique, is increasingly being used to treat... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Percutaneous curved vertebroplasty (PCVP), a modified traditional unilateral percutaneous vertebroplasty (UPVP) technique, is increasingly being used to treat osteoporotic vertebral compression fractures (OVCFs); however, its advantages remain controversial. This meta-analysis was conducted to determine whether PCVP is superior to traditional UPVP in treating OVCFs.
METHODS
Six databases were searched for studies comparing the clinical efficacy of PCVP and UPVP in treating patients with OVCFs published until March 2023. After study selection, data extraction, and risk of bias evaluation, a meta-analysis was conducted. The study protocol was registered in the PROSPERO platform (registration number: CRD42023417190).
RESULTS
Eight studies (6 randomized controlled trials and 2 cohort studies) were eligible for the final analysis. The pooled results revealed no between-group differences in operation time (P = 0.85), intraoperative fluoroscopy (P = 0.58), or postoperative short-term visual analog scale scores (P = 0.15). However, PCVP was associated with more injected cement (P = 0.003), a lower cement leakage rate (P = 0.006), and a lower final follow-up visual analog scale score (P < 0.0001).
CONCLUSIONS
PCVP was superior to UPVP in terms of reducing the bone cement leakage rate and providing long-term pain relief. Further trials with larger sample sizes and longer follow-up periods are required to verify these findings owing to the potential risk of bias.
Topics: Humans; Spinal Fractures; Fractures, Compression; Vertebroplasty; Spine; Kyphoplasty; Bone Cements; Treatment Outcome; Osteoporotic Fractures; Retrospective Studies
PubMed: 37839572
DOI: 10.1016/j.wneu.2023.10.035 -
Archives of Physical Medicine and... Jun 2024To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs). (Meta-Analysis)
Meta-Analysis
One and Done? The Effectiveness of a Single Session of Physiotherapy Compared With Multiple Sessions to Reduce Pain and Improve Function and Quality of Life in Patients With a Musculoskeletal Disorder: A Systematic Review With Meta-analyses.
OBJECTIVE
To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs).
DATA SOURCES
AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists.
STUDY SELECTION
Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs.
DATA EXTRACTION
Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation.
DATA SYNTHESIS
Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58).
CONCLUSIONS
Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.
Topics: Humans; Musculoskeletal Diseases; Pain Management; Physical Therapy Modalities; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 37805175
DOI: 10.1016/j.apmr.2023.09.017 -
Wellcome Open Research 2021Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in...
Frailty, an age-related decline in physiological reserve, is an increasingly important concept in the management of chronic diseases. The implications of frailty in people with rheumatoid arthritis are not well understood. We undertook a systematic review to assess prevalence of frailty in people with rheumatoid arthritis, and the relationship between frailty and disease activity or clinical outcomes. We searched four electronic databases (January 2001 to April 2021) for observational studies assessing the prevalence of frailty (any frailty measure) in adults (≥18 years) with rheumatoid arthritis, or analysing the relationship between frailty and disease activity or clinical outcomes (e.g. quality of life, hospitalisation or mortality) in people with rheumatoid arthritis. Study quality was assessed using an adapted Newcastle-Ottawa Scale. Screening, quality assessment and data extraction were performed independently by two reviewers. We used narrative synthesis. We identified 17 analyses, from 14 different populations. 15/17 were cross-sectional. Studies used 11 different measures of frailty. Frailty prevalence ranged from 10% (frailty phenotype) to 36% (comprehensive rheumatologic assessment of frailty) in general adult populations with rheumatoid arthritis. In younger populations (<60 or <65 years) prevalence ranged from 2.4% (frailty phenotype) to 19.9% (Kihon checklist) while in older populations (>60 or >65) prevalence ranged from 31.2% (Kihon checklist) to 55% (Geriatric 8 tool). Frailty was cross-sectionally associated with higher disease activity (10/10 studies), lower physical function (7/7 studies) and longer disease duration (2/5 studies), and with hospitalization and osteoporotic fractures (1/1 study, 3.7 years follow-up). Frailty is common in rheumatoid arthritis, including those aged <65 years, and is associated with a range of adverse features. However, these is heterogeneity in how frailty is measured. We found few longitudinal studies making the impact of frailty on clinical outcomes over time and the extent to which frailty is caused by rheumatoid arthritis unclear.
PubMed: 37746318
DOI: 10.12688/wellcomeopenres.17208.2