Response to: McKiernan FE (2008) Kyphoplasty versus vertebroplasty for management of osteoporosis. Nat Clin Pract Rheum 4: E1 doi:10.1038/ncprheum0792

Original article: Lin JT and Lane JM (2008) Nonpharmacologic management of osteoporosis to minimize fracture risk. Nat Clin Pract Rheum 4: 20–25

Editor's note: 10.1038/ncprheum0794

Our Review1 discussed relatively new treatments for osteoporosis. It was not possible for us to discuss old treatments in full because of the article constraints. Vertebroplasty has been discussed in the literature since the 1980s and its capabilities are well established. To answer Dr McKiernan, vertebroplasty provides equal pain relief to kyphoplasty but has a higher rate of secondary vertebral fractures (>30% for vertebroplasty versus 12–15% for kyphoplasty).2,3 This difference might be related to less spinal realignment. Another study has shown that untreated patients with vertebral fractures had a 30% subsequent fracture rate, whereas 12% of kyphoplasty patients experienced subsequent fracture;4 therefore, although vertebral fractures can occur after kyphoplasty, they occur at a lower rate than in patients who are left untreated or who undergo vertebroplasty. Finally, vertebroplasty has a higher cement extrusion rate than kyphoplasty due in part to a greater intervertebral pressure.5

With regard to a conflict of interests, neither author has received honoraria or consultancy fees from Kyphon Inc. in the past 4 years. Kyphon, Inc. was one of the supporters of the Osteoporosis Fragility Fracture Registry at the Hospital for Special Surgery until 2005. One of the authors is currently on the Scientific Advisory Boards of D'Fine and Soteira, both companies with an interest in vertebroplasty. In an attempt to avoid potential conflict, and because the performance of this procedure has been well documented, we chose not discuss vertebroplasty in our Review.

At our institution, vertebroplasty is currently used for painful new fractures with less than 30% collapse and for fractures in the proximal T-spine. Kyphoplasty is used for older, less-mobile fractures with greater than 30% collapse. Both procedures provide excellent pain relief. We are still in need of a randomized trial to determine the appropriate therapeutic strategies.