title: Treatment of Osteoporotic Vertebral Compression Fractures: Applicability of Appropriateness Criteria in Clinical Practice.
abstract: BACKGROUND
  Appropriate treatment choice for osteoporotic vertebral compression fractures (OVCF) is challenging due to patient heterogeneity. Using the RAND/UCLA method, an international multidisciplinary expert panel established patient-specific criteria for the choice between non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP).
  
  
  OBJECTIVE
  To assess the applicability of the appropriateness criteria in real-life practice.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Eight practices of experts who participated in the panel study, including 2 interventional radiologists, one internal medicine specialist, 2 neurosurgeons, and 3 orthopedic/trauma surgeons. Practices were located in Belgium, Germany, Italy, Switzerland, and the United Kingdom.
  
  
  METHODS
  Using an online data capture program, participants documented the clinical profile (age, gender, previous VCFs, time since fracture, magnetic resonance imaging (MRI) findings, evolution of symptoms, impact of symptoms on quality of life, spinal deformity, ongoing fracture process, and presence of pulmonary dysfunction) and treatment choice for consecutive patients who consulted them for OVCF.
  
  
  RESULTS
  In total 426 patients were included. BKP was the most frequently chosen treatment option (49%), followed by VP (34%) and NSM (14%). When compared with the panel recommendations, inappropriate treatment choices were rare (5% for NSM, 2% for VP, none for BKP). Treatment choice was strongly associated with the clinical variables used in the panel study. Differences in treatment decisions between interventional radiologists and surgeons were largely determined by differences in patient characteristics, with time of clinical presentation being the dominant factor.
  
  
  CONCLUSIONS
  The study population was restricted to the practices of the participants of the panel study.
  
  
  CONCLUSIONS
  This international, multi-specialty utilization review showed excellent applicability of, and good adherence with RAND/UCLA-based recommendations on treatment choice in OVCF.
authors.affiliation: Department of Trauma Surgery, Klinikum Bayreuth Bayreuth, Germany.
authors.forename: Rupert
authors.initials: R
authors.lastname: Schupfner
authors.affiliation: Centre for Decision Analysis and Support, Ismar Healthcare Lier, Belgium.
authors.forename: Herman J
authors.initials: HJ
authors.lastname: Stoevelaar
authors.forename: Thomas
authors.initials: T
authors.lastname: Blattert
authors.forename: Daniel
authors.initials: D
authors.lastname: Fagan
authors.forename: Patrick
authors.initials: P
authors.lastname: Fransen
authors.forename: Stefano
authors.initials: S
authors.lastname: Marcia
authors.forename: Frederic
authors.initials: F
authors.lastname: Schils
authors.forename: Mashood Ali
authors.initials: MA
authors.lastname: Siddiqi
authors.forename: Giovanni Carlo
authors.initials: GC
authors.lastname: Anselmetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005858:Germany; D006801:Humans; D038622:Internationality; D058498:Kyphoplasty / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom; D054854:Vertebroplasty / Q000379:methods