title: The incidence of secondary vertebral fracture of vertebral augmentation techniques versus conservative treatment for painful osteoporotic vertebral fractures: a systematic review and meta-analysis.
abstract: BACKGROUND
  Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear.
  
  
  OBJECTIVE
  To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures.
  
  
  METHODS
  PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted.
  
  
  RESULTS
  A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified (P > 0.05). No obvious publication bias was detected by either Begg's test (P = 0.360 > 0.05) or Egger's test (P = 0.373 > 0.05).
  
  
  CONCLUSIONS
  Despite current thinking in the field that vertebral augmentation procedures may increase the incidence of secondary fractures, we found no differences in the incidence of secondary fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs.
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Dawei
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Bin
authors.initials: B
authors.lastname: Meng
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Minfeng
authors.initials: M
authors.lastname: Gan
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Niu
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Shiyan
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China.
authors.forename: Chenxi
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Soochow University, Jiangsu, PR China yhlsuzhou@163.com.
authors.forename: Huilin
authors.initials: H
authors.lastname: Yang
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D015897:Comorbidity; D019317:Evidence-Based Medicine; D050815:Fractures, Compression / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007103:Immobilization / Q000706:statistics & numerical data; D015994:Incidence; D008137:Longitudinal Studies; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000628:therapy*; D010146:Pain / Q000453:epidemiology / Q000517:prevention & control*; D012008:Recurrence; D016103:Spinal Fractures / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000706:statistics & numerical data*
chemical_list: D000700:Analgesics; D050071:Bone Density Conservation Agents
keywords: Vertebral augmentation technique; balloon kyphoplasty; cement leakage; percutaneous vertebroplasty; secondary vertebral fracture