The New England Journal of Medicine, April 18, 2011

The pain and disability caused by osteoporotic vertebral fractures have long motivated the search for effective therapy. Two procedures designed to restore vertebral body height and function have been widely adopted: percutaneous vertebroplasty, in which cement is injected into the vertebral body to support the fractured bone; and kyphoplasty, a variant of vertebroplasty in which a balloon is inserted and inflated in a collapsed vertebral body, restoring the bone's height before the cement injection. Initial studies suggested that these procedures were superior to conventional symptomatic treatment. But when later studies cast doubt on those favorable findings, health care funding agencies sought to curb their use. The story of these procedures offers a glimpse of the ways in which comparative-effectiveness research may influence medical practice and healthcare expenditures.

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