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INTRODUCTION

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The aging population gives us cause for great concern especially in those suffering from osteoporosis. Rates are climbing, especially in women. Osteoporosis has reached epidemic proportions and is a major public health issue for an estimated 44 million Americans and 200 million people world wide. According to the 2005 annual report of The National Osteoporosis Foundation, 1 in every 2 women and 1 in every 4 men aged 50 and older suffered from osteoporosis-related fracture. Vertebral compression fractures (VCFs) constitute the most frequent complication of osteoporosis, with nearly half of all of the 2 million bone fractures caused by osteoporosis. The estimated medical cost in 2005 was over $16.9 billion. The prevalence of VCFs increases with age, reaching 40% in women over 80 years of age. Women with clinically diagnosed VCFs have a 15% higher mortality rate and are 2 to 3 times more likely to die of pulmonary causes. Over 50% of people with 1 or 2 VCFs, require self-care assistance, which is significantly higher compared to 8% of osteoarthritis patients suffering from low back pain. It is noteworthy that each VCF increases the chance of another VCF by 19.2% within the same year. Two VCFs increase the probability of a third fracture by 24% within a year.

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  • The severe pain caused by VCFs is exacerbated by movement and weight-bearing activity and is linked to significant morbidities and impaired quality of life, the majority of which is caused by pain and immobility, which can lead to:

    • Chronic pain which is often accompanied by depression and/or anxiety.

    • Reduced FVC by 9% leading to an increased risk of atelectasis and pneumonia.

    • Worsening of osteoporosis. Bone mineral density is reduced at a rate of 2% per week.

    • 1% to 3% muscle wasting per day.

    • Decubitus ulcers.

    • Higher risk of developing deep vein thrombosis and subsequent pulmonary embolism, which may be fatal.

  • Opioid medications that are prescribed for the treatment of pain can often cause loss of appetite, nausea, constipation, changes in mental status, ie, confusion and are associated with an increased risk of dependence and addiction.

  • The morbidity and mortality associated with osteoporotic vertebral fractures demand the need for more aggressive treatment. Vertebral augmentation techniques have been used as a viable treatment option providing the possibility for rapid pain relief and improved mobility. Percutaneous vertebroplasty has been considered a developing standard of care for VCFs.

  • Vertebral compression fractures may also be secondary to tumor infiltration. The most frequent malignant lesions of the spine include osteolytic metastasis and myeloma. Current cancer therapy prolongs life expectancy, although the increasing risk for these patients to develop metastatic vertebral involvement and collapse persists.

  • Galliber, Deramond, and colleagues performed the first case of percutaneous vertebroplasty in France in 1984. It was not until 1993 that Jensen and colleagues at the University of Virginia performed the first vertebroplasty in the United States.

  • Vertebroplasty has gained widespread popularity, mostly because of significantly high rates of success, low incidence ...

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