Abstract
Intravertebral clefts are considered markers for osteonecrosis. We tested the hypothesis that bisphosphonate therapy was associated with vertebral osteonecrosis. A retrospective review of a vertebroplasty database was performed. Exposure to, duration of, and type of bisphosphonate therapy was documented. Radiographs were reviewed to identify intravertebral gas-filled or fluid-filled clefts, which are considered a marker for vertebral osteonecrosis. Proportion of patients with and without clefts was compared between the group exposed to bisphosphonates and the unexposed group using Chi-squared test. Duration of bisphosphonate exposure was compared between patients with and without clefts using Student's t-test. After exclusion of 16 patients with malignancy and 21 with chronic steroid therapy 237 patients were identified. Sixty-seven (28%) of the total cohort of patients were prescribed bisphosphonate therapy. Overall, clefts were present in 68 (29%) of the 237 patients. Among the 67 patients exposed to bisphosphonate therapy, 15 patients (22%) had clefts. Among the 170 patients not exposed to bisphosphonate therapy, 53 patients (31%) had clefts (P = 0.17 compared to bisphosphonate therapy group). Mean duration of bisphosphonate therapy among patients with clefts was 52 ± 63 weeks and among patients without clefts was 57 ± 79 weeks (P = 0.80). Intravertebral clefts are not associated with bisphosphonate therapy. If these clefts indicate osteonecrosis, then bisphosphonate therapy does not appear to be associated with vertebral osteonecrosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hosford LJ (1936) Kummell’s disease. Lancet 227:49
Libicher M, Appelt A, Berger I, Baier M, Meeder PJ, Grafe I, Dafonseca K, Noldge G, Kasperk C (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17:2248–2252
Sarli M, Perez Manghi FC, Gallo R, Zanchetta JR (2005) The vacuum cleft sign: an uncommon radiological sign. Osteoporos Int 16:1210–1214
Young WF, Brown D, Kendler A, Clements D (2002) Delayed post-traumatic osteonecrosis of a vertebral body (Kummell’s disease). Acta Orthop Belg 68:13–19
Do HM, Jensen ME, Marx WF, Kallmes DF (1999) Percutaneous vertebroplasty in vertebral osteonecrosis (Kummell's spondylitis). Neurosurg Focus 7(1):e2
Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P (2006) Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res 21:1409–1416
Lane JI, Maus TP, Wald JT, Thielen KR, Bobra S, Luetmer PH (2002) Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol 23:1642–1646
McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum 48:1414–1419
Wiggins MC, Sehizadeh M, Pilgram TK, Gilula LA (2007) Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol 188:634–640
Mehrotra B, Ruggiero S (2006) Bisphosphonate complications including osteonecrosis of the jaw. Hematology Am Soc Hematol Educ Program 515:356–360
Trout AT, Kallmes DF, Lane JI, Layton KF, Marx WF (2006) Subsequent vertebral fractures after vertebroplasty: association with intraosseous clefts. AJNR Am J Neuroradiol 27:1586–1591
Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, Kallmes DF (2007) Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 28:683–689
Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H (2006) Does alendronate prevent collapse in osteonecrosis of the femoral head? Clin Orthop Relat Res 443:273–279
Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 87:2155–2159
Schortinghuis J, Meijndert L, De Visscher JG, Witjes MJ (2007) Osteonecrosis of the jaws: a secondary effect of bisphosphonates. Rev Belge Med Dent 62:168–175
Hess LM, Jeter JM, Benham-Hutchins M, Alberts DS (2008) Factors associated with osteonecrosis of the jaw among bisphosphonate users. Am J Med 121:475–483.e3
Acknowledgment
The authors thank Debra A. Lewis, PhD for assistance with statistical analysis.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kallmes, D.F., Rad, A.E., Gray, L.A. et al. Bisphosphonates are not associated with vertebral osteonecrosis. J Bone Miner Metab 27, 452–455 (2009). https://doi.org/10.1007/s00774-009-0052-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00774-009-0052-z