Management of Osteoporotic Vertebral Fracture: Review Update 2022

Abstract

A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few “gold standard treatments” outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%–35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate’s effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.

OF2 # mit sekundärer Sinterung – konservative/operative Therapie

“…Gründe hierfür sind zum einen die bestehenden Co-Morbiditäten des geriatrischen Patientenguts und zum anderen die Folgen der Frakturen an sich: chronische Schmerzen, verminderte Mobilität und damit auch Verlust der Selbstständigkeit, können den klinischen Verlauf stark beeinflussen. Ein weiteres großes Problem ist das Risiko für das Auftreten von Folgefrakturen, die dann zu einer weiteren Steigerung der Morbidität und auch Mortalität führen können [2,3].…”

“…Hierbei werden Fragilitätsfrakturen, bei denen Frakturen durch einen physiologischen Bewegungsumfang entstehen, die in einem gesunden Knochen nicht entstanden wären, von den traumatisch bedingten Frakturen unterschieden. Da auch in der Literatur beide Begriffe nicht eindeutig differenziert werden und häufig eine Mischverwendung stattfindet, wird im Weiteren der Begriff osteoporotische Wirbelkörperfraktur verwendet [3,4].…”

Role of biophysical stimulation in multimodal management of vertebral compression fractures

“…VCF by itself is a sign of bone weakness, and it requires a treatment to reverse the overall patient status and to prevent additional fractures from occurring; moreover, drugs acting on bone metabolism can play a role in patients' pain management [16] . Current drugs include bisphosphonates, calcitonin, estrogen, selective estrogen receptor modulators, parathyroid hormone, and receptor activators of nuclear factor kappa-B ligand inhibitor [17] .…”

“…Analgesics are the first line in vertebral compression fracture treatment, generally administrating nonsteroidal anti-inflammatory drugs (NSAIDs). Opioids such as oxycodone can be combined with paracetamol for patients who do not respond well to first-line pain relievers [16] . Among antidepressants, Inhibitors of the Reuptake of Serotonin (SSRIs) can be used short-term in association with standard therapy to control pain in the acute phase in fragile patients; its main drawbacks are the risk of falling at high dosage and light sedation in chronic assumption [24] .…”

Paravertebral Nerve Block for Procedural Pain in Percutaneous Vertebroplasty

“…S ince Galibert et al 1 first reported in 1984 among patients with an aggressive vertebral angioma, percutaneous vertebroplasty (PVP) has become the standard treatment for painful thoracolumbar osteoporotic vertebral compression fractures (OVCFs), OVCF osteonecrosis, vertebral pathologic fracture, and aggressive vertebral hemangioma, despite remaining a controversial procedure. [2][3][4][5][6] However, a substantial proportion of patients undergo PVP without an adequate intraoperative analgesic procedure, and procedural pain during PVP often tends to be overlooked in clinical practice. In addition, these procedures may result in painful experiences for patients.…”