When the pain gets to be too much for those suffering from spinal bone fractures due to osteoporosis, there are generally two options: bed rest (often combined with a protective brace and painkillers) or a controversial procedure known as a vertebroplasty, which involves injections of bone cement.
In a vertebroplasty, a surgeon uses a hollow-point needle to inject a cementlike substance, typically poly(methyl methacrylate), or PMMA, into any cracks or fractures found in the spine. (Although osteoporosis weakens bones throughout the body, vertebroplasty is used exclusively to treat spinal problems.) The surgeon will also use a fluoroscope, which includes an X-ray device and a fluorescent screen, to monitor the needle's location inside the body and ensure that the sealant is injected into the proper location.
Both approaches to curbing the pain associated with vertebral compression fractures—a condition that affects about 1.4 million people worldwide, with more than half of those cases in the U.S.—have their detractors and supporters.
Proponents of bed rest note that most patients' fractures heal without the need for any type of medical procedure, although this could take several weeks. Bed-rest advocates see vertebroplasty as a treatment that is unnecessary at best and could actually leave the treated bone around the cement in a weakened condition. Two studies published earlier this month in The New England Journal of Medicine (NEJM ) appear to support these views, finding that participants in a study who received vertebroplasty felt no less pain than participants who were given a placebo treatment, in which no bone cement was injected into the spine.
In one of the studies, 131 patients suffering from osteoporotic vertebral compression fractures underwent either a vertebroplasty or a simulated procedure where the bone cement was not actually used. Much to the surprise of the researchers, both sets of patients showed immediate improvement after the procedure, says David Kallmes, a professor of radiology in the Mayo Clinic's radiology department who participated in the research. "My sense is that (vertebroplasty) is overused now," he says, adding that he does perform the procedure. One concern, which he expressed after a 2006 Mayo Clinic study of vertebroplasty, is that vertebrae adjacent to fractures treated with bone cement tend to fracture significantly sooner than vertebrae farther away.
Others are concerned with the use of PMMA, a clear plastic that's also an ingredient in Plexiglas (commonly used as a shatterproof replacement for glass) and Lucite, which is used to make the surfaces of hot tubs, sinks and one-piece bathtub–shower units, among other things. Although vertebroplasty complications are extremely rare, there is a danger of the cement leaking outside of the spinal area and potentially causing infection, bleeding, numbness and other problems.