Skip to main content
SpringerLink
Log in

Appropriateness criteria for treatment of osteoporotic vertebral compression fractures

  • Review
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The purpose of this study was to review and summarise the literature on appropriateness criteria for treatment of osteoporotic vertebral compression fractures (OVCF), with appropriateness defined as a treatment where the expected benefits outweigh the expected harms, confirmed by available evidence and expert opinion. A comprehensive search of peer-reviewed publications (PubMed, EMBASE) and grey literature was performed. To be included for analysis, documents had to be a review article (e.g. clinical guideline or meta-analysis), focus on OVCF and make a statement on treatment appropriateness. Eleven publications fulfilled the eligibility criteria. Among the five publications that made recommendations about non-surgical management (NSM), there is agreement that conservative methods are appropriate in OVCF patients who have low level of pain, and that the majority of patients should be treated with conservative methods before other treatments are initiated. All publications made recommendations about vertebral augmentation procedures (VAP), i.e. vertebroplasty (VP) and/or balloon kyphoplasty (BKP). VAP are mostly considered appropriate in patients with high level of pain who do not respond to NSM. However, results cannot be generalised due to heterogeneity of treatment recommendations and patient selection. Although there is a consensus that NSM should be considered as the first-line treatment, there is more heterogeneity in treatment recommendations for VAP. This could most likely be explained by an insufficient clinical evidence base for VAP and heterogeneity of OVCF patients, leading to greater reliance on expert opinion affecting the quality of evidence in the primary sources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Search strings: PubMed; (osteoporo*[tiab] AND (vertebral[tiab] OR spinal[tiab]) AND compression[tiab] AND fracture*[tiab]) AND (appropriate*[tiab] OR criteria[tiab] OR guideline[tiab] OR guidance[tiab] OR “position statement”[tiab] OR standard*[tiab] OR consensus[tiab] OR recommend*[tiab] OR “patient selection” [tiab] OR indication) AND ((“2000/01/01”[PDat]: “2016/12/31”[PDat]) AND English[lang])

    EMBASE; osteoporo*:ab,ti AND vertebral:ab,ti AND (‘compression’/exp. OR compression:ab,ti) AND (‘fracture’/exp. OR fracture:ab,ti) AND (appropriate*:ab,ti OR criteria:ab,ti OR guideline:ab,ti OR guidance:ab,ti OR ‘position statement’:ab,ti OR standard*:ab,ti OR consensus:ab,ti OR recommend*:ab,ti OR ‘patient selection’:ab,ti OR indication:ab,ti) AND [2000–2016]/py AND [english]/lim AND ([article]/lim OR [article in press]/lim OR [conference paper]/lim OR [review]/lim)

References

  1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. https://doi.org/10.1007/s00198-006-0172-4

    Article  CAS  PubMed  Google Scholar 

  3. Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA, Finn JD et al (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res Off J Am Soc Bone Miner Res 17(4):716–724

    Article  CAS  Google Scholar 

  4. Borgstrom F, Olafsson G, Strom O, Tillman JB, Wardlaw D, Boonen S et al (2013) The impact of different health dimensions on overall quality of life related to kyphoplasty and non-surgical management. Osteoporos Int 24(7):1991–1999. https://doi.org/10.1007/s00198-012-2237-x

    Article  CAS  PubMed  Google Scholar 

  5. Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25(8):1987–1997

    CAS  PubMed  Google Scholar 

  6. Bornemann R, Koch EM, Wollny M, Pflugmacher R (2014) Treatment options for vertebral fractures an overview of different philosophies and techniques for vertebral augmentation. Eur J Orthop Surg Traumatol 24(Suppl 1):S131–S143

    Article  PubMed  Google Scholar 

  7. Stevenson M, Gomersall T, Lloyd Jones M, Rawdin A, Hernandez M, Dias S et al (2014) Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis. Health Technol Assess (Winchester, England) 18(17):1–290

    Google Scholar 

  8. Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):S27–S31. https://doi.org/10.1016/8756-3282(92)90193-Z

    Article  PubMed  Google Scholar 

  9. Venmans A, Klazen CA, Lohle PN, Mali WP, van Rooij WJ (2012) Natural history of pain in patients with conservatively treated osteoporotic vertebral compression fractures: results from VERTOS II. AJNR Am J Neuroradiol 33(3):519–521. https://doi.org/10.3174/ajnr.A2817

    Article  CAS  PubMed  Google Scholar 

  10. Lee HM, Park SY, Lee SH, Suh SW, Hong JY (2012) Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures (OVCFs): conservative treatment versus balloon kyphoplasty. Spine J 12(11):998–1005. https://doi.org/10.1016/j.spinee.2012.08.024

    Article  PubMed  Google Scholar 

  11. Goz V, Errico TJ, Weinreb JH, Koehler SM, Hecht AC, Lafage V, Qureshi SA (2015) Vertebroplasty and kyphoplasty: national outcomes and trends in utilization from 2005 through 2010. Spine J 15(5):959–965. https://doi.org/10.1016/j.spinee.2013.06.032

    Article  PubMed  Google Scholar 

  12. Wang H, Sribastav SS, Ye F, Yang C, Wang J, Liu H, Zheng Z (2015) Comparison of percutaneous Vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: a meta-analysis of the literature. Pain Physician 18(3):209–222

    PubMed  Google Scholar 

  13. Ma XL, Xing D, Ma JX, Xu WG, Wang J, Chen Y (2012) Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis. Eur Spine J 21(9):1844–1859. https://doi.org/10.1007/s00586-012-2441-6

    Article  PubMed  PubMed Central  Google Scholar 

  14. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31(23):2747–2755. https://doi.org/10.1097/01.brs.0000244639.71656.7d

    Article  PubMed  Google Scholar 

  15. Truumees E, Hilibrand A, Vaccaro AR (2004) Percutaneous vertebral augmentation. Spine J: Off J North Am Spine Soc 4(2):218–229. https://doi.org/10.1016/j.spinee.2003.08.029

    Article  Google Scholar 

  16. Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE (1986) A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 2(1):53–63. https://doi.org/10.1017/S0266462300002774

    Article  CAS  PubMed  Google Scholar 

  17. Daroui P, Jabbour SK, Herman JM, Abdel-Wahab M, Azad N, Blackstock AW, Das P, Goodman KA, Hong TS, Jones WE 3rd, Kaur H, Konski AA, Koong AC, Kumar R, Pawlik TM, Small W Jr, Thomas CR Jr, Suh WW (2015) ACR Appropriateness Criteria(R) resectable stomach cancer. Oncology (Williston Park, NY) 29(8):595–602 C3

    Google Scholar 

  18. Jolly S, Soni P, Gaffney DK, Biagioli M, Elshaikh MA, Jhingran A et al (2015) ACR Appropriateness Criteria(R) adjuvant therapy in vulvar cancer. Oncology (Williston Park, NY) 29(11):867–872, 74–75

  19. Earls JP, White RD, Woodard PK, Abbara S, Atalay MK, Carr JJ, Haramati LB, Hendel RC, Ho VB, Hoffman U, Khan AR, Mammen L, Martin ET III, Rozenshtein A, Ryan T, Schoepf J, Steiner RM, White CS (2011 Oct) ACR Appropriateness Criteria(R) chronic chest pain—high probability of coronary artery disease. J Am Coll Radiol: JACR 8(10):679–686. https://doi.org/10.1016/j.jacr.2011.06.022

    Article  PubMed  Google Scholar 

  20. Garbi M, McDonagh T, Cosyns B, Bucciarelli-Ducci C, Edvardsen T, Kitsiou A, Nieman K, Lancellotti P, On behalf of the EACVI Imaging Task Force (2015) Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review. Eur Heart J Cardiovasc Imaging 16(2):147–153. https://doi.org/10.1093/ehjci/jeu299

    Article  PubMed  Google Scholar 

  21. Anselmetti GC, Bernard J, Blattert T, Court C, Fagan D, Fransen H, Fransen P, Sabharwal T, Schils F, Schupfner R, Siddiqi MA, Stoevelaar H, Kasperk C (2013) Criteria for the appropriate treatment of osteoporotic vertebral compression fractures. Pain Physician. 16(5):E519–E530

    PubMed  Google Scholar 

  22. McConnell CT Jr, Wippold FJ 2nd, Ray CE Jr, Weissman BN, Angevine PD, Fries IB et al (2014) ACR appropriateness criteria management of vertebral compression fractures. J Am Coll Radiol: JACR 11(8):757–763. https://doi.org/10.1016/j.jacr.2014.04.011

    Article  PubMed  Google Scholar 

  23. Schupfner R, Stoevelaar HJ, Blattert T, Fagan D, Fransen P, Marcia S, Schils F, Siddiqi MA, Anselmetti GC (2016) Treatment of osteoporotic vertebral compression fractures: applicability of appropriateness criteria in clinical practice. Pain Physician. 19(1):E113–E120

    PubMed  Google Scholar 

  24. Spinal Intervention Society (SIS) Appropriate Use Criteria [2015–11-04]. Available from: http://www.spinalinjection.org/?page=S1_AUC

  25. American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria [2015–11-04]. Available from: http://www.aaos.org/research/Appropriate_Use/auc_new.asp

  26. American College of Radiology (ACR) ACR Appropriateness Criteria® [2015–11-04]

  27. North American Spine Society (NASS) Appropriate Use Criteria 2015 [2015–11-04]. Available from: https://www.spine.org/ResearchClinicalCare/QualityImprovement/AppropriateUseCriteria.aspx

  28. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1. https://doi.org/10.1186/2046-4053-4-1

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brouwers M, Kho M, Browman G, Cluzeau F, Feder G, Fervers B et al (2010) AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J 182(18):E839–E842. https://doi.org/10.1503/cmaj.090449

    Article  Google Scholar 

  30. McConnell Jr CT (2013) ACR Appropriateness Criteria®—management of vertebral compression fractures-evidence table

  31. Barr J, Jensen M, Hirsch J, McGraw J, Barr R, Brook A et al (2014) Position statement on percutaneous vertebral augmentation: a consensus statement developed by the Society of Interventional Radiology (SIR), American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), American College of Radiology (ACR), American Society of Neuroradiology (ASNR), American Society of Spine Radiology (ASSR), Canadian interventional radiology association (CIRA), and the Society of NeuroInterventional surgery (SNIS). J Vasc Interv Radiol 25(2):171–181. https://doi.org/10.1016/j.jvir.2013.10.001

    Article  PubMed  Google Scholar 

  32. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568. https://doi.org/10.1056/NEJMoa0900429

    Article  CAS  PubMed  Google Scholar 

  33. Farrokhi MR, Alibai E, Maghami Z (2011) Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 14(5):561–569. https://doi.org/10.3171/2010.12.SPINE10286

    Article  PubMed  Google Scholar 

  34. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579. https://doi.org/10.1056/NEJMoa0900563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet (London, England) 376(9746):1085–1092

    Article  Google Scholar 

  36. Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J (2009) Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine 34(13):1349–1354. https://doi.org/10.1097/BRS.0b013e3181a4e628

    Article  PubMed  Google Scholar 

  37. Rousing R, Hansen KL, Andersen MO, Jespersen SM, Thomsen K, Lauritsen JM (2010) Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine 35(5):478–482. https://doi.org/10.1097/BRS.0b013e3181b71bd1

    Article  PubMed  Google Scholar 

  38. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J et al (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet (London, England) 373(9668):1016–1024

    Article  Google Scholar 

  39. Brunton S, Carmichael B, Gold D, Hull B, Kauffman T, Papaioannou A, Rasch R, Stracke HH, Truumees E, Primary Care Education Consortium, Texas Academy of Family Physicians (2005) Vertebral compression fractures in primary care: recommendations from a consensus panel. J Fam Pract 54(9):781–788

    PubMed  Google Scholar 

  40. American Academy of Orthopaedic Surgeons (AAOS) (2010) The treatment of symptomatic osteoporotic spinal compression fractures—guideline and evidence report. Rosemont

  41. Karliner L (2009) Balloon kyphoplasty as a treatment for vertebral compression fractures. San Francisco

  42. National Institute for Health and Care Excellence Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures [Technology appraisal guidance no. 279]. 2013 [updated 26 January 2017]. Available from: http://www.nice.org.uk/guidance/ta279

  43. Blasco J, Martinez-Ferrer A, Macho J, San Roman L, Pomes J, Carrasco J et al (2012) Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Miner Res Off J Am Soc Bone Miner Res 27(5):1159–1166. https://doi.org/10.1002/jbmr.1564

    Article  Google Scholar 

  44. Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D (2011) Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res Off J Am Soc Bone Miner Res 26(7):1627–1637. https://doi.org/10.1002/jbmr.364

    Article  Google Scholar 

  45. Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH, Chen YH, Lin TB (2010) Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 21(2):359–364. https://doi.org/10.1007/s00198-009-0952-8

    Article  CAS  PubMed  Google Scholar 

  46. Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28(3):555–560

    CAS  PubMed  Google Scholar 

  47. National Institute for Health and Care Excellence. Percutaneous vertebroplasty 2003 [updated 26 January 2017]. Available from: http://www.nice.org.uk/guidance/ipg12

  48. Ontario Health Technology Advisory Committee OHTAC recommendation percutaneous vertebroplasty for treatment of painful osteoporotic vertebral compression fractures presented to the Ontario Health Technology Advisory Committee in May 2010 [updated 26 January 2017]. Available from: http://www.hqontario.ca/english/providers/program/ohtac/tech/recommend/rec_vertebroplasty_osteo_20100930.pdf

  49. Ontario Health Technology Advisory Committee OHTAC recommendation balloon kyphoplasty for treatment of painful osteoporotic vertebral compression fractures presented to the Ontario Health Technology Advisory Committee in June 2010 [updated 26 January 2017]. Available from: http://www.ontla.on.ca/library/repository/mon/24011/305778.pdf

  50. Buchbinder R, Golmohammadi K, Johnston RV, Owen RJ, Homik J, Jones A et al (2015) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 30(4):CD006349

    Google Scholar 

  51. Chen D, An ZQ, Song S, Tang JF, Qin H (2014) Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures. J Clin Neurosci 21(3):473–477. https://doi.org/10.1016/j.jocn.2013.05.017

    Article  PubMed  Google Scholar 

  52. Dohm M, Black CM, Dacre A, Tillman JB, Fueredi G (2014) A randomized trial comparing balloon kyphoplasty and vertebroplasty for vertebral compression fractures due to osteoporosis. AJNR Am J Neuroradiol 35(12):2227–2236. https://doi.org/10.3174/ajnr.A4127

    Article  CAS  PubMed  Google Scholar 

  53. Endres S, Badura A (2012) Shield kyphoplasty through a unipedicular approach compared to vertebroplasty and balloon kyphoplasty in osteoporotic thoracolumbar fracture: a prospective randomized study. Orthop Traumatol, Surg Res: OTSR 98(3):334–340. https://doi.org/10.1016/j.otsr.2011.11.010

    Article  CAS  PubMed  Google Scholar 

  54. Vogl TJ, Pflugmacher R, Hierholzer J, Stender G, Gounis M, Wakhloo A, Fiebig C, Hammerstingl R (2013) Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty: results of a controlled, randomized trial. Spine 38(20):1730–1736. https://doi.org/10.1097/BRS.0b013e3182a14d15

    Article  PubMed  Google Scholar 

  55. Diamond TH, Bryant C, Browne L, Clark WA (2006) Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 184(3):113–117

    PubMed  Google Scholar 

  56. Grohs JG, Matzner M, Trieb K, Krepler P (2005) Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech 18(3):238–242

    PubMed  Google Scholar 

  57. De Negri P, Tirri T, Paternoster G, Modano P (2007) Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 23(5):425–430. https://doi.org/10.1097/AJP.0b013e31805593be

    Article  PubMed  Google Scholar 

  58. Grafe I, Fonseca K, Hillmeier J, Meeder P-J, Libicher M, Nöldge G et al (2005) Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis. Osteoporos Int 16(12):2005–2012. https://doi.org/10.1007/s00198-005-1982-5

    Article  PubMed  Google Scholar 

  59. Wong CC, McGirt MJ (2013) Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc 6:205–214. https://doi.org/10.2147/JMDH.S31659

    PubMed  PubMed Central  Google Scholar 

  60. Papanastassiou ID, Phillips FM, Van Meirhaeghe J, Berenson JR, Andersson GB, Chung G et al (2012) Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J 21(9):1826–1843. https://doi.org/10.1007/s00586-012-2314-z

    Article  PubMed  PubMed Central  Google Scholar 

  61. Baerlocher MO, Munk PL, Liu DM, Tomlinson G, Badii M, Kee ST, Loh CT, Hardy BW, Murphy KJ (2010) Clinical utility of vertebroplasty: need for better evidence. Radiology 255(3):669–674. https://doi.org/10.1148/radiol.10092107

    Article  PubMed  Google Scholar 

  62. Bolster MB (2010 Jan) Consternation and questions about two vertebroplasty trials. Cleve Clin J Med 77(1):12–16. https://doi.org/10.3949/ccjm.77a.09161

    Article  PubMed  Google Scholar 

  63. Aebi M (2009) Vertebroplasty: about sense and nonsense of uncontrolled “controlled randomized prospective trials”. Eur Spine J 18(9):1247–1248. https://doi.org/10.1007/s00586-009-1164-9

    Article  PubMed  PubMed Central  Google Scholar 

  64. Munk PL, Liu DM, Murphy KP, Baerlocher MO (2009) Effectiveness of vertebroplasty: a recent controversy. Can Assoc Radiol J 60(4):170–171. https://doi.org/10.1016/j.carj.2009.08.001

    Article  PubMed  Google Scholar 

  65. Smith SJ, Vlahos A, Sewall LE (2010) An objection to the New England Journal of Medicine vertebroplasty articles. Can Assoc Radiol J 61(2):121–122. https://doi.org/10.1016/j.carj.2010.01.010

    Article  PubMed  Google Scholar 

  66. Weinstein JN (2009) Balancing science and informed choice in decisions about vertebroplasty. N Engl J Med 361(6):619–621. https://doi.org/10.1056/NEJMe0905889

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was funded by Medtronic International Trading Sarl.

Author information

Authors and Affiliations

  1. Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden

    S. Luthman, J. Widén & F. Borgström

  2. LIME/MMC, Karolinska Institutet, Stockholm, Sweden

    F. Borgström

Authors
  1. S. Luthman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Widén
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Borgström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Widén.

Ethics declarations

Conflict of interest

F. Borgström is employed by and owns stock in Quantify Research AB, a contract research organisation within health economics and outcomes research. S. Luthman and J. Widén are employed by Quantify Research AB.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luthman, S., Widén, J. & Borgström, F. Appropriateness criteria for treatment of osteoporotic vertebral compression fractures. Osteoporos Int 29, 793–804 (2018). https://doi.org/10.1007/s00198-017-4348-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4348-x

Keywords

Search

Navigation