We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Treatment of Osteoporotic Vertebral Fractures

Michaël Laurent, MD1
[+] Author Affiliations
1Division of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
JAMA Intern Med. 2014;174(4):641-642. doi:10.1001/jamainternmed.2013.13482.
Text Size: A A A
Published online


To the Editor McCullough et al1 reported that apparent mortality reductions following vertebroplasty and kyphoplasty likely result from selection bias. These findings are important to counter hasty conclusions from several recent population-based studies and reviews. Yet these new results are hardly surprising, given the a priori lack of evidence to assume a causal association between vertebral fractures and mortality, let alone mortality risk modifiable by targeting the spine. Reduced pulmonary function following vertebral fracture would be a plausible mechanistic explanation, but only small, short-term improvements in vital capacity following vertebral augmentation have been demonstrated. Contrary to the frequently cited increased risk of pulmonary deaths in older women with prevalent vertebral fractures in the Study of Osteoporotic Fractures, incident vertebral fractures (arguably the stronger outcome) in that cohort were no longer associated with mortality following adjustment for other determinants such as frailty.2 The same authors have further shown that hyperkyphosis and height loss are equally unfavorable, independent of vertebral fractures and their characteristics,3 arguing against a direct role of the latter.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





April 1, 2014
Brendan J. McCullough, MD, PhD; Richard A. Deyo, MD, MPH; Jeffrey G. Jarvik, MD, MPH
1Department of Health Services, University of Washington, Seattle
5Department of Family Medicine, Oregon Health and Science University, Portland6Department of Medicine, Oregon Health and Science University, Portland7Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland8Center for Research in Occupational and Environmental Toxicology, Oregon Health and Science University, Portland9Kaiser Permanente Center for Health Research, Portland, Oregon
1Department of Health Services, University of Washington, Seattle2Department of Radiology, University of Washington, Seattle3Department of Neurological Surgery, University of Washington, Seattle4Department of Pharmacy, University of Washington, Seattle
JAMA Intern Med. 2014;174(4):642-643. doi:10.1001/jamainternmed.2013.13481.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...