What type of study is this?

This is a Network Meta-Analysis study.

September 10, 2025Open Access

Optimal management for osteoporotic vertebral compression fractures: a network meta-analysis

Key Points

Third-generation percutaneous vertebral augmentation provides better pain relief than non-surgical management in osteoporotic vertebral compression fractures.
On average, pain intensity decreased more significantly with TVA and PKP compared to non-surgical management at both short-term and long-term follow-ups.
This network meta-analysis involved 46 studies that compared various interventions for osteoporotic vertebral compression fractures and measured multiple outcomes.
The findings suggest that while PKP preserves vertebral body height, TVA generally improves pain, disability, and quality of life more effectively than other methods.

Abstract

Abstract Background Optimal management of osteoporotic vertebral compression fractures (OVCFs) remains controversial. This network meta‑analysis (NMA) evaluated the relative efficacy and safety of third‑generation percutaneous vertebral augmentation (TVA), percutaneous kyphoplasty (PKP), percutaneous vertebroplasty (PVP), and non‑surgical management (NSM) in OVCFs. Methods A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from inception to February 1, 2025, to identify clinical trials comparing ≥ 2 of these interventions. Primary outcomes included pain intensity (Visual Analog Scale VAS), functional disability (Oswestry Disability Index ODI), quality of life (EQ‑5D), and anterior vertebral body height (AVB). Adverse events, including adjacent vertebral fracture (AVF) and bone cement leakage (BCL), were also assessed. Results Forty‑six studies (23 RCTs and 23 comparative cohort studies; n = 5,660) were included. Both TVA and PKP yielded greater VAS reductions than NSM at short‑term (≤ 6 months; MD − 1.28 and − 1.37; 95% CI − 1.62 to − 0.93 and − 1.82 to − 0.92) and long‑term (> 6 months; MD − 0.86 and − 0.69; 95% CI − 1.22 to − 0.50 and − 1.20 to − 0.19) follow‑up. TVA outperformed NSM in ODI improvement at short‑term (MD − 6.84; 95% CI − 9.84 to − 3.84) and long‑term (MD − 9.14; 95% CI − 14.64 to − 3.65); PKP surpassed NSM short‑term (MD − 5.59; 95% CI − 9.32 to − 1.86) but was inferior to TVA long‑term (MD 8.34; 95% CI 2.62 to 14.06). Surgical interventions uniformly outperformed NSM in quality‑of‑life gains. TVA and PKP achieved greater AVB restoration than NSM, whereas PVP carried a higher BCL risk compared to TVA and PKP. NSM was associated with the lowest probability of AVF (90.2%). Conclusions Although PKP offers the greatest long‑term preservation of AVB, third‑generation TVA appears superior to PVP, PKP, and NSM in improving pain, functional disability, quality of life, and safety in OVCF patients. High‑quality randomized trials with extended follow‑up are required to confirm these findings.

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Cite This Study

Li et al. (Sat,) studied this question.

synapsesocial.com/papers/68c1dda254b1d3bfb60fc793 https://doi.org/https://doi.org/10.1186/s13018-025-06233-w

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