Abstract
Corticosteroid-induced osteoporosis is the most common cause of drug-related osteoporosis and appears frequently in the patients affected from rheumatoid arthritis with high rate of pathological vertebral compression fractures (VCFs). The consequences of VCFs include pain related to the fracture and spinal kyphosis. The aim of treatment of osteoporosis is to halt bone loss, to reduce pain and to prevent the occurrence of future fractures through osteoinduction. The treatment of osteoporotic VCFs ideally should address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty entails the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity created by the IBT to reduce the kyphosis and repair the fracture. Twenty-nine corticosteroid-induced osteoporotic VCFs were treated during 21 balloon kyphoplasty procedures in 17 patients. Standing radiographs centered on the treated level/s obtained prekyphoplasty and postkyphoplasty were analysed for improvement in sagittal alignment using the Cobb technique. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period. Mean improvement in local sagittal alignment was 11.3° (range 0°–32°). All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain, with 11 patients reporting no pain whatsoever. Corticosteroid-induced osteoporotic VCFs present a significant economic burden to society and result in severe clinical consequences leading to impaired function, reduced pulmonary function and overall increase in mortality. Traditional medical option including bed rest, bracing and analgesics have proven to be insufficient. Patients with rheumatoid arthritis treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
