Two articles in today’s New England Journal of Medicine are the first randomized placebo controlled trials of vertebroplasty, a procedure which involves injecting cement into the vertebrae of people who have suffered from painful osteoporotic fractures of the vertebrae. In the first study 78 patients got either vertebroplasty or a fake procedure. There was no difference in pain ratings measured at several time points out to six months.

The second study involved 131 patients who got either a sham or vertebroplasty procedure. There were no differences in the primary outcomes of pain or disability at one month after treatment. There was a pattern of clinical improvement in pain (30% reduction in pain, 64% v 48%, p=0.06) that was not one of the original study outcomes. The group that got the sham procedure, however, were more likely to request a repeat procedure (i.e. got a vertebroplasty in the end) (43% v 12%, p<.05). Some of the authors said they were “shocked” by the results and others said they should do “more research” or that it “might help some patients” or “maybe they want a placebo” since the fake group got better as well as the vertebroplasty group. Maybe they should pay the $4,000 for the MRI and procedure out of their pockets rather than billing it to Medicare so that they have a better placebo response. That would help out on President Barack Obama’s plans to reduce US healthcare costs by eliminating the 30% of tests and procedures that have been found to be useless. He can add this one to the list.