Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

Abstract

Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%–35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.

Unstable Bony Chance Fracture Successfully Treated With Teriparatide in Patient With Ankylosed Spine: A Case Report and Review of the Literature

“…In the present case, a fracture developed at the thoracolumbar junction, which has been considered to be an unstable region because of the transition zone between long and stiff kyphotic thoracic spine and mobile lordotic lumbar spine. 10 Especially, IVC at 3 months after trauma suggested unstable fracture in this patient; this was different from previous reports and presented as collapsed anterior vertebral height in the standing position compared to the supine position ( Figure 4 ). 14 In case of definite fracture instability as present case, conservative treatment including teriparatide could be considered because patient complained of tolerable mechanical back pain without neurologic deficits.…”

“…1 , 3 Thus, surgical management is strongly recommended for stability of spinal column and fracture healing. 10 - 12 However, we report a first case of successful teriparatide treatment of unstable bony Chance fracture at thoracolumbar junction in DISH patient.…”

Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey

“…Moreover, it should be noted how calcium, vitamin D, and amino acids supplementation should be considered in a multidisciplinary integrated intervention combined with lifestyle education to prevent or to counteract the developing of osteosarcopenia [ 3 , 49 , 50 , 51 , 52 ]. Almost 70% of the PRM physicians involved prescribed therapeutic exercise in their clinical practice; these findings are in line with the available literature suggesting its beneficial effects of exercise in terms of pain, posture, physical performance, and HRQoL [ 53 , 54 , 55 , 56 , 57 ]. In this scenario, a recent Cochrane Systematic Review performed by Gibbs et al [ 58 ] supported exercise therapy as an effective intervention in functional outcomes improvement in patients suffering from osteoporotic vertebral fractures with moderate evidence.…”

Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

“…However, studies have shown that approximately 30% of all OVCFs presents with progressive collapse, 13% accompanied with nonunion, and 3% develops delayed vertebral collapse (DVC) with neurologic deficits [ 1 , 2 ]. Moreover, osteoporosis may impair bone healing of the vertebral fracture, causing a collapse in the vertebral body and intervertebral disk height, aggravating segmental kyphosis, and consequently resulting in spinal segmental instability [ 3 – 5 ].…”