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Providing pain relief and reducing opioid use for seniors with osteoporotic fractures

Sunday, April 12, during the Pain Management/MSK 1 session at 3 p.m.

SIR Annual Scientific Meeting Abstracts
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Percutaneous Vertebral Augmentation After Osteoporotic Vertebral Compression Fracture: A Retrospective Cohort Analysis of 27,912 Patients

Z. Hussain, T. Ayaz, A. Harb, S. Abdullah, A. Saleem

Percutaneous vertebral augmentation can lower one-year mortality and reduce chronic opioid exposure, according to a new review of seniors with osteoporotic fractures.

“Osteoporotic vertebral fractures are common, disabling and linked to high mortality,” said lead author Zain S. Hussain, MD. “Payers, especially Medicare, continue to question the value of augmentation procedures, particularly under evolving prior authorization and reimbursement models.”

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To provide contemporary, real‑world evidence, researchers examined outcomes in nearly 28,000 patients drawn from a nationwide electronic health record network after the new WISeR prior authorization program was introduced.

“We compared augmentation (vertebroplasty or kyphoplasty) versus no procedure, after propensity matching for age, sex, comorbidities and baseline factors,” said Dr. Hussain. “Outcomes included mortality, cardiopulmonary complications, pulmonary embolism, pneumonia, infection, subsequent fractures, repeat augmentation, opioid use and new admissions to skilled nursing facilities.”

According to Dr. Hussain, several clinically actionable takeaways emerged from their review.

Not only was augmentation associated with a lower 1-year mortality risk (~4%), but serious procedural complications were rare, occurring at less than 0.2% of patients. Additionally, they found no meaningful increase in PE, pneumonia, cardiopulmonary events or infection. However, subsequent fractures and repeat procedures were common.

“These numbers suggest augmentation can prolong life and reduce opioid reliance, but long-term skeletal fragility remains a major failure point,” Dr. Hussain said.

While one of the primary goals of the initial review was to provide comprehensive data to show the value of PVA, Dr. Hussain said there is additional follow-up planned, such as linking augmentation to downstream osteoporosis treatment patterns to quantify whether anti-fracture therapy changes new fracture risk. They also aim to stratify outcomes by fracture acuity, procedural technique and operator type.

“We also will evaluate cost and health-economic impacts—including repeat procedures, readmission, skilled nursing facility utilization and opioid prescribing trends,” Dr. Hussain said. “These analyses will inform not just clinical practice patterns, but payer coverage and authorization policy going forward.”

The big picture, according to Dr. Hussain, is that while PVA helps patients live longer and stay mobile, it alone cannot stop the fracture cascade.

“The next leap is pairing procedural care with mandatory secondary fracture prevention pathways,” he said. “We believe this is the clearest path to lower mortality, fewer refractures, and sustainable reimbursement for IR-led vertebral care.”

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