Effect of Preoperative Zoledronic Acid Administration on Pain Intensity after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Abstract

Introduction. This study aimed to compare and analyze the effect of preoperative zoledronic acid (ZOL) administration on pain intensity after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods. The study included 242 patients with OVCFs who underwent PVP in our hospital between January 2015 and June 2018. The patients were randomly assigned to either a ZOL group (n = 121) or a control group (n = 121). The patients in the ZOL group were treated preoperatively with intravenous infusion of 5 mg ZOL. Those in the control group were treated without ZOL. All the patients were followed up for 1 year. Results. No statistically significant differences in age, sex, weight, and body mass index (BMI) were found between the two groups. During the follow-up period, the visual analog scale score and Oswestry dysfunction index score in the ZOL group were lower than those in the control group. The bone mineral density at 6 or 12 months after treatment was significantly higher and the levels of the bone metabolism markers were significantly lower in the ZOL group than in the control group (P<0.05 for both). Two patients in the treatment group had new vertebral fractures, whereas 13 patients in the control group had new vertebral fractures, which translate to recompression vertebral fracture incidence rates of 1.7% and 10.7%, respectively. The incidence rate of mild adverse reactions was significantly higher in the ZOL group than in the control group, but all the cases were endurable. Conclusion. Intravenous infusion of ZOL before PVP can effectively reduce postoperative pain intensity, reduce bone loss, increase bone density, reduce the risk of refracture, and improve patient quality of life.

Clinical Efficacy and Safety of Zoledronic Acid Combined with PVP/PKP in the Treatment of Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In addition, the trends for the indexes persisted at 12 months, indicating the stable and durable effect of the ZA injection. Hu et al revealed that ZA treatment exerted a good inhibitory effect after 12 months [32]. Notably, 2 studies performed follow-up of the radiological results, and no significant differences were detected in the Cobb angle and VBH at 12 mo after the operation.…”

“…The underlying mechanism by which PKP/PVP reduces pain remains unclear [ 28 ]. Nevertheless, a few compelling mechanisms have been proposed: heat caused by bone cement could cauterize nerve endings [ 29 ] and stabilize vertebral bodies [ 30 , 31 ], resulting in peripheral nerve ischemia and necrosis by embolizing blood vessels [ 32 ]. Despite the doubts of a correlation between pain relief and radiological outcomes, several studies confirmed the efficacy in the early stage [ 33 – 35 ].…”

“…In addition, the trends for the indexes persisted at 12 months, indicating the stable and durable effect of the ZA injection. Hu et al revealed that ZA treatment exerted a good inhibitory effect after 12 months [ 32 ].…”

Factors and Strategies for Post-Vertebroplasty Residual Pain from Thoracolumbar Osteoporotic Vertebral Compression Fractures (OVCF): a systematic review.

“…As all we known, zoledronic acid could inhabit osteoclasts differentiate and proliferate, regulate bone metabolism and reduce bone loss. In this article, 6 retrospective studies [32][33][34][35][36][37] and 2 prospective studies [38,39]were searched out. 7 studies [32][33][34][35][37][38][39] reported the effect of ZOL and one study [37] reported the effect of Teriparatide.1416 cases, 574 cases in test group and 842 cases in control group, who had residual pain in back or low back were observed.…”

“…ZOL was used on the second or third day after surgery in the above studies. Hu W et al [34]reported a controlled study of 121 OVCF patients were injected with ZOL before PVP surgery. The results showed that patients in the test group had lower pain scores after one year of followup.…”