S3 Guideline Was Not Mentioned

Percutaneous Vertebroplasty in Vertebral Compression Fractures of Benign or Malignant Origin: A Prospective Study of 1188 Patients With Follow-up of 12 Months by Dr. med. Anastasios Mpotsaris, Razmin Abdolvahabi, Bastian Hoffleith, Dr. med. Janpeter Nickel, Dr. med. Ali Harati, Dr. med. Christian Loehr, Dr. med. Chun Hee Gerdes, Dr. med. Svenja Hennigs, PD Dr. med. Werner Weber in volume 19/2011

In the study reported by Mpotsaris et al., osteoporosis was the cause of the vertebral fractures treated with vertebroplasty in three out of four cases. The authors even conclude that the “socioeconomically most important group of patients with vertebral body fractures, namely, those whose fractures are due to osteoporosis” experienced clinical improvement potentially for up to six months.

The authors do not mention the written consensus of the German governing body for osteology (Dachverband Osteologie, DVO) on the prophylaxis, diagnostic evaluation, and treatment of osteoporosis in adults, in the form of the S3 guideline (www.dv-osteologie.org/dvo_leitlinien/dvo-leitlinie-2009), published first in 2006 and updated in 2009. In this guideline, vertebroplasty and kyphoplasty are discussed and it is recommended that interdisciplinary discussion of the individual case and a documented attempt at conservative treatment should precede the intervention, as should excluding degenerative changes as the cause of the existing pain.

In the present article, the authors “retrospectively” conclude that the selection of suitable patients is an important criterion for achieving good results during follow-up. The authors must have been unfamiliar with the cited S3 guideline as such a selection should already be routine standard these days. Maybe this is also why readers do not learn what is used to provide the osteoporosis patients with osteoprotective treatment, although this may influence the degree of pain and constitutes the actual treatment for osteoporosis, which particularly needs to be taken into consideration in this group of patients. Furthermore I wish to point out that the authors acknowledge in their article the limitation of the lacking control group, but do not deal with the possible distortion of results owing to the “placebo effect” of the intervention. Publications on this topic can also be found at www.dv-osteologie.org.

DOI: 10.3238/arztebl.2012.0076b

Dr. med. Friederike Thomasius

Osteoporose-Studiengesellschaft bR, Frankfurt

Conflict of interest statement
Dr Thomasius has received honoraria from MSD for preparing scientific continuing medical educational events. Furthermore she has received honoraria for conducting clinical studies on behalf of and from Amgen.

References

1. Mpotsaris A, Abdolvahabi R, Hoffleith B, et al.: Percutaneous vertebroplasty in vertebral compression fractures of benign or malignant origin: a prospective study of 1188 patients with follow-up of 12 months. Dtsch Arztebl Int 2011; 108(19): 331–8.