Osteoporosis International

, Volume 16, Issue 12, pp 2005–2012 | Cite as

Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis

  • Ingo A. Grafe
  • Katharina Da Fonseca
  • Jochen Hillmeier
  • Peter-Jürgen Meeder
  • Martin Libicher
  • Gerd Nöldge
  • Hubert Bardenheuer
  • Walter Pyerin
  • Linus Basler
  • Christel Weiss
  • Rod S. Taylor
  • Peter Nawroth
  • Christian KasperkEmail author
Original Article


Previously, we reported significantly reduced pain and improved mobility persisting for 6 months after kyphoplasty of chronically painful osteoporotic vertebral fractures in the first prospective controlled trial. Since improvement of spinal biomechanics by restoration of vertebral morphology may affect the incidence of fracture, long-term clinical benefit and thereby cost-effectiveness, here we extend our previous work to assess occurrence of new vertebral fractures and clinical parameters 1 year after kyphoplasty compared with a conservatively treated control group. Sixty patients with osteoporotic vertebral fractures due to primary osteoporosis were included: 40 patients were treated with kyphoplasty, 20 served as controls. All patients received standard medical treatment. Morphological characteristics, new vertebral fractures, pain (visual analog scale), physical function [European Vertebral Osteoporosis Study (EVOS) score] (range 0–100 each) and back-pain-related doctors’ visits were re-assessed 12 months after kyphoplasty. There were significantly fewer patients with new vertebral fractures of the thoracic and lumbar spine, after 12-months, in the kyphoplasty group than in the control group (P=0.0084). Pain scores improved from 26.2 to 44.4 in the kyphoplasty group and changed from 33.6 to 34.3 in the control group (P=0.008). Kyphoplasty treated patients required a mean of 5.3 back-pain-related doctors’ visits per patient compared with 11.6 in the control group during 12 months follow-up (P=0.006). Kyphoplasty as an addition to medical treatment and when performed in appropriately selected patients by an interdisciplinary team persistently improves pain and reduces occurrence of new vertebral fractures and healthcare utilization for at least 12 months in individuals with primary osteoporosis.


Kyphoplasty Mobility Osteoporosis Pain Vertebral fracture Vertebroplasty 



We are grateful for the support of this study by Biomet Darmstadt, Germany, Kyphon Europe, the Deutsche Forschungsgemeinschaft and by the Havemann family. Dr Taylor serves as a consultant for Kyphon Europe. All other authors have no conflict of interest.


  1. 1.
    Lieberman IH, Dudeney S, Reinhardt MK, et al (2001) Initial outcome and efficacy of kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638PubMedGoogle Scholar
  2. 2.
    Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515PubMedGoogle Scholar
  3. 3.
    Philips FM, Ho E, Campbell-Hupp M, et al (2003) Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine 28:2260–2267PubMedGoogle Scholar
  4. 4.
    Kasperk C, Hillmeier J, Noeldge G, et al (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res 20:604–612PubMedGoogle Scholar
  5. 5.
    Klotzbuecher CM, Ross PD, Landsmen PB, et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedGoogle Scholar
  6. 6.
    Lindsay R, Silverman SL, Cooper C, et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedGoogle Scholar
  7. 7.
    Melton LJ 3rd, Atkinson EJ, Cooper C, et al (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221PubMedGoogle Scholar
  8. 8.
    Kanis JA, Johansson H, Oden A, et al (2004) A family history of fracture risk: a meta-analysis. Bone 35:1029–1037PubMedGoogle Scholar
  9. 9.
    Da Fonseca K, Grafe I, Hillmeier J, et al (2004) Kyphoplastik mit “Biozement”. J Miner Stoffwechs 11 [Suppl 1]:16–19Google Scholar
  10. 10.
    Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14 [Suppl 3]:S43–S55Google Scholar
  11. 11.
    Rea JA, Chen MB, Li J, et al (2001) Vertebral morphometry: a comparison of long-term precision of morphometric X-ray absorptiometry and morphometric radiography in normal and osteoporotic subjects. Osteoporos Int 12:158–166PubMedGoogle Scholar
  12. 12.
    Black DM, Palermo L, Nevitt MC, et al (1999) Defining incident vertebral deformity; a prospective comparison of several approaches. J Bone Miner Res 14:90–101PubMedGoogle Scholar
  13. 13.
    Knop C, Oeser M, Bastian L, et al (2001) Development and validation of the visual analogue scale (VAS) spine score. Unfallchirurg 104:488–497PubMedGoogle Scholar
  14. 14.
    O’Neill TW, Cooper C, Algra D, et al (1995) Design and development of a questionnaire for use in a multicentre study of vertebral osteoporosis in Europe: the European Vertebral Osteoporosis Study (EVOS). Rheumatol Eur 24:75–81Google Scholar
  15. 15.
    O’Neill TW, Cooper C, Cannata JB, et al (1994) Reproducibility of a questionnaire on risk factors for osteoporosis in a multicentre prevalence survey: The European Vertebral Osteoporosis Study. Int J Epidemiol 23:559–565PubMedGoogle Scholar
  16. 16.
    Coumans JVCE, Reinhardt MK, Lieberman IH (2003) Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study. J Neurosurg 99:44–50Google Scholar
  17. 17.
    Ledlie JT, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98:36–42PubMedGoogle Scholar
  18. 18.
    Rhyne A, Banit D, Laxer E, et al (2004) Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 18:294–299PubMedGoogle Scholar
  19. 19.
    Berlemann U, Franz T, Orler R, et al (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study. Eur Spine J 4;42–48Google Scholar
  20. 20.
    Donovan MA, Khandji AG, Siris E (2004) Multiple adjacent vertebral fractures after kyphoplasty in a patient with steroid-induced osteoporosis. J Bone Miner Res 19:712–713PubMedGoogle Scholar
  21. 21.
    Harrop JS, Prpa B, Reinhardt MK, et al (2004) Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty. Spine 29:2120–2125PubMedGoogle Scholar
  22. 22.
    Fribourg D, Tang C, Sra P, et al (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine. 29:2270–2276Google Scholar
  23. 23.
    Heaney RP (1992) The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenon? Bone 13 [Suppl 2]:23–26Google Scholar
  24. 24.
    Djoumessi RM, Maalouf G, Maalouf N, et al (2004) Loss of regularity in the curvature of the thoracolumbar spine: a measure of structural failure. J Bone Miner Res 19:1099–1104PubMedGoogle Scholar
  25. 25.
    Duan Y, Seeman E, Turner CH (2001) The biomechanical basis of vertebral body fragility in men and women. J Bone Miner Res 16:2276–2283PubMedGoogle Scholar
  26. 26.
    Lunt M, O’Neill TW, Felsenberg D, et al, for the European Prospective Osteoporosis Study Group (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513PubMedGoogle Scholar
  27. 27.
    Ettinger B, Black DM, Nevitt MC, et al (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456PubMedGoogle Scholar
  28. 28.
    Nakano M, Hirano N, Matsuura K, et al (2002) Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures. J Neurosurg 97 [3 Suppl]:287–293Google Scholar
  29. 29.
    Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265PubMedGoogle Scholar
  30. 30.
    Watts NB, Harris ST, Genant HK (2001) Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporosis Int 12:429–437CrossRefGoogle Scholar
  31. 31.
    Oddsson LI, De Luca CJ (2003) Activation imbalances in lumbar spine muscles in the presence of chronic low back pain. J Appl Physiol 94:1410–1420PubMedGoogle Scholar
  32. 32.
    Ferguson SA, Marras WS, Burr DL, et al (2004) Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions. Clin Biomech 19:992–999CrossRefGoogle Scholar
  33. 33.
    Zerwekh JE, Ruml LA, Gottschalk F, et al (1998) The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res 13:1594–1601PubMedGoogle Scholar
  34. 34.
    Liegibel UM, Sommer U, Tomakidi P, et al (2002) Concerted action of androgens and mechanical strain shifts bone metabolism from high turnover into an osteoanabolic mode. J Exp Med 196:1387–1392PubMedGoogle Scholar
  35. 35.
    Ethgen O, Tellier V, Sedrine WB, et al (2003) Health-related quality of life and cost of ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers? Bone 32:718–724PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Ingo A. Grafe
    • 1
  • Katharina Da Fonseca
    • 2
  • Jochen Hillmeier
    • 2
  • Peter-Jürgen Meeder
    • 2
  • Martin Libicher
    • 3
  • Gerd Nöldge
    • 3
  • Hubert Bardenheuer
    • 4
  • Walter Pyerin
    • 5
  • Linus Basler
    • 2
  • Christel Weiss
    • 6
  • Rod S. Taylor
    • 7
  • Peter Nawroth
    • 1
  • Christian Kasperk
    • 1
    Email author
  1. 1.Department of Medicine I, Division of OsteologyRuprecht-Karls-University of HeidelbergHeidelbergGermany
  2. 2.Department of SurgeryUniversity of HeidelbergHeidelbergGermany
  3. 3.Department of RadiologyUniversity of HeidelbergHeidelbergGermany
  4. 4.Department of AnesthesiologyUniversity of HeidelbergHeidelbergGermany
  5. 5.German Cancer Research Center (DKFZ)HeidelbergGermany
  6. 6.Department of Medical StatisticsUniversity of HeidelbergHeidelbergGermany
  7. 7.Department of Public Health and EpidemiologyUniversity of BirminghamBirminghamUK

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