Response Letter to the Editor—Diamond et al, <i>JBMR</i>

Ebeling, Peter R.; Åkesson, Kristina; Bauer, Douglas C.; Buchbinder, Rachelle; Eastell, Richard; Fink, Howard A; Giangregorio, Lora; Guañabens, Núria; Kado, Deborah M.; Kallmes, David F.; Katzman, Wendy B.; Rodríguez, Alexander J.; Wermers, Robert A.; Wilson, H Alexander; Bouxsein, Mary L.

doi:10.1002/jbmr.3724

Cited by 2 publications

(1 citation statement)

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“…We thank Ning and colleagues for their question on the relationship of pain duration to the effects of vertebroplasty, in relationship to our article. (1) In response, we refer the authors to the updated Cochrane review, (2) an individual patient data metaanalysis including two placebo-controlled trials, (3) and our response to a previous letter, (4) which provides comprehensive answers to their queries. The Cochrane review includes a detailed description and potential risk of bias of each of the trials included in the evidence synthesis that formed the basis of our conclusions about the value of vertebroplasty for treatment of painful osteoporotic vertebral fractures.…”

Section: To the Editormentioning

confidence: 99%

Response to: Some Questions About the Article “The Efficacy and Safety of Vertebral Augmentation: A Second ASBMR Task Force Report”

Buchbinder

Ebeling

Åkesson

et al. 2019

Journal of Bone and Mineral Research

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To the EditorWe thank Ning and colleagues for their question on the relationship of pain duration to the effects of vertebroplasty, in relationship to our article. (1) In response, we refer the authors to the updated Cochrane review, (2) an individual patient data metaanalysis including two placebo-controlled trials, (3) and our response to a previous letter, (4) which provides comprehensive answers to their queries. The Cochrane review includes a detailed description and potential risk of bias of each of the trials included in the evidence synthesis that formed the basis of our conclusions about the value of vertebroplasty for treatment of painful osteoporotic vertebral fractures. (2) Three of the five placebo-controlled trials included in the review only included acute fractures, which was defined variously as pain duration of <6 weeks in the VAPOUR trial, ≤8 weeks, (5) and <9 weeks. (6) Although the other two trials included some participants with longer symptom duration (mean duration 9 to 9.5 weeks in Buchbinder and colleagues, (7) and 16 to 20 weeks in Kallmes and colleagues (8) ), the individual patient data meta-analysis clearly reports that 40% and 20% of participants in the Australian and US trials, respectively, had symptoms for ≤6 weeks. (3) The Cochrane review found that overall, based upon high-quality to moderate-quality evidence from five placebocontrolled trials (541 randomized participants), vertebroplasty has no important benefit over placebo in terms of pain, disability, quality of life, or treatment success in the treatment of acute or subacute osteoporotic vertebral fractures. (2) A subgroup analysis found that these results were consistent irrespective of average duration of pain, indicating that symptom duration is not a treatment-effect modifier. For example, based upon five trials with 378 participants with acute symptoms (including data from all three trials with only participants with acute fractures, and participants with symptoms for 6 weeks or less from the other two trials), the mean difference in pain at 1 month was -0.25 (95% CI, -0.47 to -0.

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