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Minimally invasive repair of painful vertebral compression fractures has become an established treatment for osteoporosis. The development of similar techniques to treat other fractures caused by age and metastatic disease could be a cost-effective way to deal with declining reimbursements and a growing elderly population.

Percutaneous osteoplastic techniques treating common insufficiency-type fractures affecting the pelvis, sacrum, and long bones are gaining attention. Like vertebroplasty, these techniques rely on the injection of cement or other compounds to stabilize the lesion. Some also combine the effects of thermal ablation when fractures are caused by tumors.

Researchers at the University of British Columbia have released results of a study that combined radiofrequency ablation and cement-based osteoplasty in patients with painful vertebral, acetabular, sacral, and pelvic fractures produced by tumors. Eleven patients underwent 15 combined RFA and cementoplasties with a 100% technical success rate and no major complications.

Another investigative team from Indian River Radiology in Vero Beach, FL, performed a prospective study comparing polymethylmeth­acrylate (PMMA) with a new, more malleable polymer-based injectable material for vertebroplasty (Cortoss, Orthovita). The investigators have enrolled a total of 256 patients over three years and have found Cortoss to be as effective and safe as PMMA. Both studies were presented at the 2008 Society of Interventional Radiology meeting.

Though common, insufficiency fractures are underrecognized and undertreated, said Dr. Douglas P. Beall, chief of musculoskeletal imaging at the University of Oklahoma Health Sciences Center. About 40% of women and 25% of men will have to deal with these disabling lesions during their lifetime.