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Published in: European Journal of Trauma and Emergency Surgery 1/2017

01-02-2017 | Original Article

Conservative management of osteoporotic vertebral fractures: an update

Authors: A. Slavici, M. Rauschmann, C. Fleege

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2017

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Abstract

Purpose

Adequate conservative management of osteoporotic vertebral fractures remains important in an aging population.

Methods

We performed a research of multiple databases and present important studies in this narrative review.

Results

The pertinent literature remains scarce and of mixed quality. However, trends are shown to support early mobilization, less rigid bracing and pharmaceutical secondary prevention.

Conclusion

There is insufficient data to recommend the optimal conservative management for osteoporotic vertebral fractures. As such high-quality studies need to be conducted to establish a solid course of action.
Literature
1.
2.
go back to reference Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009; 361:557–68. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009; 361:557–68.
3.
go back to reference Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):596–7.CrossRef Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361(6):596–7.CrossRef
4.
go back to reference AAOS. The treatment of symptomatic osteoporotic spinal compression fractures guideline and evidence report. Rosemont: American Academy of Orthopaedic Surgeons; 2010. AAOS. The treatment of symptomatic osteoporotic spinal compression fractures guideline and evidence report. Rosemont: American Academy of Orthopaedic Surgeons; 2010.
5.
go back to reference Liu J, Li X, Tang D, et al. Comparing pain reduction following vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Pain Phys. 2013;16:455–64. Liu J, Li X, Tang D, et al. Comparing pain reduction following vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Pain Phys. 2013;16:455–64.
8.
go back to reference Anderson P, Froyshteter A, Tontz W. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28:372–82. doi:10.1002/jbmr.1762.CrossRefPubMed Anderson P, Froyshteter A, Tontz W. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28:372–82. doi:10.​1002/​jbmr.​1762.CrossRefPubMed
9.
go back to reference Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999;159:1215–20.CrossRefPubMed Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999;159:1215–20.CrossRefPubMed
10.
go back to reference Ensrud KE, Blackwell TL, Fink HA, et al. What proportion of incident radiographic vertebral fractures in older men is clinically diagnosed and vice versa: a prospective study. J Bone Miner Res. 2016;31:1500–3. doi:10.1002/jbmr.2831.CrossRefPubMed Ensrud KE, Blackwell TL, Fink HA, et al. What proportion of incident radiographic vertebral fractures in older men is clinically diagnosed and vice versa: a prospective study. J Bone Miner Res. 2016;31:1500–3. doi:10.​1002/​jbmr.​2831.CrossRefPubMed
11.
go back to reference Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800.CrossRefPubMed Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800.CrossRefPubMed
14.
go back to reference Ojo F, Snih S, Ray L, et al. History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans. J Natl Med Assoc. 2007;99:412–8.PubMedPubMedCentral Ojo F, Snih S, Ray L, et al. History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans. J Natl Med Assoc. 2007;99:412–8.PubMedPubMedCentral
19.
go back to reference Gaughen JR Jr, Jensen ME, Schweickert PA, et al. Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty. J Vasc Interv Radiol. 2002;13:1135–8.CrossRefPubMed Gaughen JR Jr, Jensen ME, Schweickert PA, et al. Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty. J Vasc Interv Radiol. 2002;13:1135–8.CrossRefPubMed
21.
go back to reference Lin HH, Chou PH, Wang ST, et al. Determination of the painful level in osteoporotic vertebral fractures—retrospective comparison between plain film, bone scan, and magnetic resonance imaging. J Chin Med Assoc. 2015;78(12):714–8.CrossRefPubMed Lin HH, Chou PH, Wang ST, et al. Determination of the painful level in osteoporotic vertebral fractures—retrospective comparison between plain film, bone scan, and magnetic resonance imaging. J Chin Med Assoc. 2015;78(12):714–8.CrossRefPubMed
23.
go back to reference Takahashi S, Hoshino M, Takayama K, et al. Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study. Osteoporos Int. 2016. doi:10.1007/s00198-016-3737-x. Takahashi S, Hoshino M, Takayama K, et al. Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study. Osteoporos Int. 2016. doi:10.​1007/​s00198-016-3737-x.
24.
go back to reference Ahn S, Ryu K, Park J, et al. Early Bone marrow edema pattern of the osteoporotic vertebral compression fracture: can be predictor of vertebral deformity types and prognosis? J Korean Neurosurg S. 2016;59:137–42. doi:10.3340/jkns.2016.59.2.137.CrossRef Ahn S, Ryu K, Park J, et al. Early Bone marrow edema pattern of the osteoporotic vertebral compression fracture: can be predictor of vertebral deformity types and prognosis? J Korean Neurosurg S. 2016;59:137–42. doi:10.​3340/​jkns.​2016.​59.​2.​137.CrossRef
25.
go back to reference Kaup M, Wichmann J, Scholtz J-E, et al. Dual-energy CT-based display of bone marrow edema in osteoporotic vertebral compression fractures: impact on diagnostic accuracy of radiologists with varying levels of experience in correlation to MR imaging. Radiology. 2016;280:510–9. doi:10.1148/radiol.2016150472.CrossRefPubMed Kaup M, Wichmann J, Scholtz J-E, et al. Dual-energy CT-based display of bone marrow edema in osteoporotic vertebral compression fractures: impact on diagnostic accuracy of radiologists with varying levels of experience in correlation to MR imaging. Radiology. 2016;280:510–9. doi:10.​1148/​radiol.​2016150472.CrossRefPubMed
26.
go back to reference Zhao QM, Gu XF, Liu ZT, Cheng L. The value of radionuclide bone imaging in defining fresh fractures among osteoporotic vertebral compression fractures. J Craniofac Surg. 2016;27(3):745–8.PubMed Zhao QM, Gu XF, Liu ZT, Cheng L. The value of radionuclide bone imaging in defining fresh fractures among osteoporotic vertebral compression fractures. J Craniofac Surg. 2016;27(3):745–8.PubMed
27.
31.
go back to reference Rzewuska M, Ferreira M, McLachlan A, et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. Eur Spine J. 2015;24:702–14. doi:10.1007/s00586-015-3821-5.CrossRefPubMed Rzewuska M, Ferreira M, McLachlan A, et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. Eur Spine J. 2015;24:702–14. doi:10.​1007/​s00586-015-3821-5.CrossRefPubMed
33.
go back to reference Vestergaard P, Hermann P, Jensen J-E, et al. Effects of paracetamol, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, and opioids on bone mineral density and risk of fracture: results of the Danish Osteoporosis Prevention Study (DOPS). Osteoporos Int. 2011;23:1255–65. doi:10.1007/s00198-011-1692-0.CrossRefPubMed Vestergaard P, Hermann P, Jensen J-E, et al. Effects of paracetamol, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, and opioids on bone mineral density and risk of fracture: results of the Danish Osteoporosis Prevention Study (DOPS). Osteoporos Int. 2011;23:1255–65. doi:10.​1007/​s00198-011-1692-0.CrossRefPubMed
34.
go back to reference Vorsanger GJ, Farell J, Xiang J. Tapentadol, oxycodone or placebo for acute pain of vertebral compression fractures: a randomized phase IIIb study. Pain Manag. 2013;3(2):109–18.CrossRefPubMed Vorsanger GJ, Farell J, Xiang J. Tapentadol, oxycodone or placebo for acute pain of vertebral compression fractures: a randomized phase IIIb study. Pain Manag. 2013;3(2):109–18.CrossRefPubMed
39.
go back to reference Newman M, Minns Lowe C, Barker K. Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Arch Phys Med Rehabil. 2016;97(6):1013–25.CrossRefPubMed Newman M, Minns Lowe C, Barker K. Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Arch Phys Med Rehabil. 2016;97(6):1013–25.CrossRefPubMed
45.
go back to reference Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, et al. Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord. 2010;11:36.CrossRefPubMedPubMedCentral Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, et al. Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord. 2010;11:36.CrossRefPubMedPubMedCentral
46.
go back to reference Malmros B, Mortensen L, Jensen MB, Charles P. Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int. 1998;8(3):215–21.CrossRefPubMed Malmros B, Mortensen L, Jensen MB, Charles P. Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int. 1998;8(3):215–21.CrossRefPubMed
47.
go back to reference Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc. 2004;52(9):1471–8.CrossRefPubMed Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc. 2004;52(9):1471–8.CrossRefPubMed
49.
go back to reference Sinaki M, BreyRH Hughes CA, et al. Significant reduction in risk of falls and pain in osteoporotic-kyphotic women through a spinal proprioceptive extension exercise dynamic (SPEED) program. Mayo Clin Proc. 2005. doi:10.4065/80.7.849.PubMed Sinaki M, BreyRH Hughes CA, et al. Significant reduction in risk of falls and pain in osteoporotic-kyphotic women through a spinal proprioceptive extension exercise dynamic (SPEED) program. Mayo Clin Proc. 2005. doi:10.​4065/​80.​7.​849.PubMed
50.
go back to reference Kemmler W, Kohl M, von Stengel S. Long-term effects of exercise in postmenopausal women: a 16-year result of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Menopause; 2016. doi:10.1097/GME.0000000000000720. Kemmler W, Kohl M, von Stengel S. Long-term effects of exercise in postmenopausal women: a 16-year result of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Menopause; 2016. doi:10.​1097/​GME.​0000000000000720​.
51.
go back to reference Itoi E, et al. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc. 1994;69(11):1054–9.CrossRefPubMed Itoi E, et al. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc. 1994;69(11):1054–9.CrossRefPubMed
53.
go back to reference Jansen J, Bergman G, Huels J, Olson M. The efficacy of bisphosphonates in the prevention of vertebral, hip, and nonvertebral-nonhip fractures in osteoporosis: a network meta-analysis. Semin Arthritis Rheum. 2011;40(275–284):e2. doi:10.1016/j.semarthrit.2010.06.001. Jansen J, Bergman G, Huels J, Olson M. The efficacy of bisphosphonates in the prevention of vertebral, hip, and nonvertebral-nonhip fractures in osteoporosis: a network meta-analysis. Semin Arthritis Rheum. 2011;40(275–284):e2. doi:10.​1016/​j.​semarthrit.​2010.​06.​001.
54.
55.
go back to reference Knopp J, Diner B, Blitz M, et al. Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int. 2005;16:1281–90. doi:10.1007/s00198-004-1798-8.CrossRefPubMed Knopp J, Diner B, Blitz M, et al. Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int. 2005;16:1281–90. doi:10.​1007/​s00198-004-1798-8.CrossRefPubMed
56.
go back to reference Endo N, Fujino K, Doi T, et al. Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial. J Bone Miner Metab. 2016. doi:10.1007/s00774-016-0765-8. Endo N, Fujino K, Doi T, et al. Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial. J Bone Miner Metab. 2016. doi:10.​1007/​s00774-016-0765-8.
57.
go back to reference Bolland MJ, Grey AB, Gamble GD, Reid IR. Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab. 2010. doi:10.1210/jc.2009-0852. Bolland MJ, Grey AB, Gamble GD, Reid IR. Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab. 2010. doi:10.​1210/​jc.​2009-0852.
61.
go back to reference Chen Y-C, Lin W-C. Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures? BMC Musculoskelet Dis. 2016;17:151. doi:10.1186/s12891-016-1003-1.CrossRef Chen Y-C, Lin W-C. Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures? BMC Musculoskelet Dis. 2016;17:151. doi:10.​1186/​s12891-016-1003-1.CrossRef
63.
go back to reference Capozzi A, Lello S, Pontecorvi A. The inhibition of RANK-ligand in the management of postmenopausal osteoporosis and related fractures: the role of denusomab. Gynecol Endocrinol. 2015. doi:10.3109/09513590.2014.892067. Capozzi A, Lello S, Pontecorvi A. The inhibition of RANK-ligand in the management of postmenopausal osteoporosis and related fractures: the role of denusomab. Gynecol Endocrinol. 2015. doi:10.​3109/​09513590.​2014.​892067.
65.
go back to reference Park J-H, Kang K-C, Shin D-E, et al. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int. 2014;25:613–8. doi:10.1007/s00198-013-2458-7.CrossRefPubMed Park J-H, Kang K-C, Shin D-E, et al. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int. 2014;25:613–8. doi:10.​1007/​s00198-013-2458-7.CrossRefPubMed
66.
go back to reference Fahrleitner-Pammer A, Langdahl BL, Marin F, et al. Fracture rate and back pain during and after discontinuation of teriparatide: 36-month data from the European Forsteo Observational Study (EFOS). Osteoporos Int. 2011;22:2709–19. doi:10.1007/s00198-010-1498-5.CrossRefPubMed Fahrleitner-Pammer A, Langdahl BL, Marin F, et al. Fracture rate and back pain during and after discontinuation of teriparatide: 36-month data from the European Forsteo Observational Study (EFOS). Osteoporos Int. 2011;22:2709–19. doi:10.​1007/​s00198-010-1498-5.CrossRefPubMed
67.
go back to reference Hoshino M, Tsujio T, Terai H, et al. Al impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976). 2013. doi:10.1097/BRS.0b013e31828ced9d. Hoshino M, Tsujio T, Terai H, et al. Al impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976). 2013. doi:10.​1097/​BRS.​0b013e31828ced9d​.
69.
go back to reference Venmans A, Klazen CA, Lohle PNM, et al. Natural history of pain in patients with conservatively treated osteoporotic vertebral compression fractures: results from VERTOS II. Am J Neuroradiol. 2012;33:519–21. doi:10.3174/ajnr.A2817.CrossRefPubMed Venmans A, Klazen CA, Lohle PNM, et al. Natural history of pain in patients with conservatively treated osteoporotic vertebral compression fractures: results from VERTOS II. Am J Neuroradiol. 2012;33:519–21. doi:10.​3174/​ajnr.​A2817.CrossRefPubMed
70.
go back to reference Voormolen MH, Mali WP, Lohle PN, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007;28:555–60.PubMed Voormolen MH, Mali WP, Lohle PN, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007;28:555–60.PubMed
Metadata
Title
Conservative management of osteoporotic vertebral fractures: an update
Authors
A. Slavici
M. Rauschmann
C. Fleege
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2017
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0747-5

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