LAUSR

Dear Editor, We are pleased to see that the paper BThe variability of vertebral body volume and pain associated with osteoporotic vertebral fractures: conservative treatment versus percutaneous transpedicular vertebroplasty^ [1] has raised interest among our colleagues as it approached a debatable topic. We thank Drs. Liu,Wu, KXZhang and LYZhang for sharing their experience and point of view regarding the subject. We were aware at that time of the studies conducted by Kobayashi et al. [2] and Yang et al. [3], and their results showed that, with no doubt, patients after vertebroplasty are mobilized within the first 24 hours, but, when opting for conservative treatment, bed rest is indicated for two weeks as a part of therapy. We considered that it is customary to conduct the therapy in thismanner, and there is no need to debate about this topic. Although we encourage our patients to use anti-osteoporosis therapy, their adherence to the medication is difficult to assess and the beneficial effect is still controversial. Most treatment types for osteoporosis act predominantly by inhibiting osteoclasts activity, hence, decreasing bone resorption. While clinical trials, generally performed over three years, have shown these drugs to be effective in reducing the incidence of fracture, concerns have been expressed over the negative effect of longterm suppression of bone remodeling to produce adverse effects affecting bone strength or increasing fracture risk [4]. As suggested by Adler et al., long-term biphosphonates use is based on limited evidence, only to reduce the risk of vertebral fracture, mainly in white postmenopausal women, and it does not replace the need for clinical judgment [4]. Recent reports of atypical fractures in patients receiving bisphosphonates, the most commonly used treatment for osteoporosis, have attracted much attention in this respect [5, 6]. More than that, bone quality represents a notion that is difficult to define and has to include aspects such as toughness, strength, resistance to failure, load-bearing capacity and so on. More recent definitions include a number of aspects that are part of a single concept that include bone intrinsic material properties, bone remodeling, bone microarchitecture and bone mass [7]. For these reasons, the use of anti-osteoporosis medication is not the subject of this study. More than that, we mentioned and excluded from the study the patients with newly developed vertebral fractures: "There were four newly developed fractures at an adjacent level in three patients in the vertebroplasty group and five vertebral fractures in three patients including three vertebral fractures at an adjacent level in the second group up to one year after injury". There are many other studies [8–11] such as the one we conducted, that reported no relevant clinical complication. It was stated in the paper that: "All patients in both groups were prescribed similar analgesia, i.e. non-steroidal anti-inflammatory drugs (NSAID) and physical exercises, in bed or at our rehabilitation centre". Our results demonstrated that the two groups differ significantly in terms of pain, and in terms of analgesic drug requirement and mobility. The facet joint injections are indeed a viable additional technique that can be used for pain relief in patients with kyphosis due to vertebral compression fractures, but it lies outside the subject of our paper. Concluding, we agree with Dr. Liu,Wu, KXZhang and LY Zhang that further studies have to take into consideration the aspects mentioned by them to thoroughly stratify the patients and provide cause-effect conclusions, but we have to bear in * Iulian Popa [email protected]