Introduction: Most Vertebral Compression Fractures (VCFs) are caused by osteoporosis. This diagnosis is based on clinical and radiological findings. Even in patients with proven osteoporosis it is not always the true cause of the fractures. In literature, outcomes of bone-biopsies obtained during vertebroplasty have been described with inconsistent outcome in percentages of unexpected malignancy.

Methods: In order to determine the rate of unsuspected malignancy, ninety-eight biopsies were obtained from 81 patients (20 male, 61 female, mean age 69 years). The histological diagnosis of vertebral body biopsy specimens were analyzed in a retrospective study.

Results: Eighty-one biopsies, (82,7%) obtained from 70 patients, were suitable for histological evaluation. In a total of eleven patients (15,7%) there was a malignancy histological diagnosed, including eight patients with metastasis from a known primary tumor. Three patients (4,3%) were diagnosed with a previously undiagnosed malignancy, in two patients (2,9%) multiple myeloma and one patient (1,4%) chondrosarcoma was diagnosed. In the multiple myeloma patients the disease was in stage 1 and 2 at the time of histological diagnosis. In the remaining 70 biopsies no evidence of malignancy was found. This group contained 13 patients having a known primary malignancy, two patients with chronic corticosteroid use and four patients with a history of radiation therapy. In 10 biopsies there were no signs of osteoporosis or any other cause for the compression fracture.

Conclusion: A bone biopsy during a vertebroplasty procedure is a necessity and should routinely be performed in patients undergoing vertebroplasty procedures to rule out an unsuspected malignancy. In this study a relatively high rate of newly diagnosed malignancies as cause of VCFs was found.