Management of vertebral compression fracture in general practice: BEACH program

Abstract

ImportanceThe pain associated with vertebral compression fractures can cause significant loss of function and quality of life for older adults. Despite this, there is little consensus on how best to manage this condition.ObjectiveTo describe usual care provided by general practitioners (GPs) in Australia for the management of vertebral compression fractures.Design, setting and participantsData from the Bettering the Evaluation And Care of Health (BEACH) program collected between April 2005 and March 2015 was used for this study. Each year, a random sample of approximately 1,000 GPs each recorded information on 100 consecutive encounters. We selected those encounters at which vertebral compression fracture was managed. Analyses of management options were limited to encounters with patients aged 50 years or over.Main outcome(s) and measure(s)i) patient demographics; ii) diagnoses/problems managed; iii) the management provided for vertebral compression fracture during the encounter. Robust 95% confidence intervals, adjusted for the cluster survey design, were used to assess significant differences between group means.ResultsVertebral compression fractures were managed in 211 (0.022%; 95% CI: 0.018–0.025) of the 977,300 BEACH encounters recorded April 2005– March 2015. That provides a national annual estimate of 26,000 (95% CI: 22,000–29,000) encounters at which vertebral fractures were managed. At encounters with patients aged 50 years or over (those at higher risk of primary osteoporosis), prescription of analgesics was the most common management action, particularly opioids analgesics (47.1 per 100 vertebral fractures; 95% CI: 38.4–55.7). Prescriptions of paracetamol (8.2; 95% CI: 4–12.4) or non-steroidal anti-inflammatory drugs (4.1; 95% CI: 1.1–7.1) were less frequent. Non-pharmacological treatment was provided at a rate of 22.4 per 100 vertebral fractures (95% CI: 14.6–30.1). At least one referral (to hospital, specialist, allied health care or other) was given for 12.3 per 100 vertebral fractures (95% CI: 7.8–16.8).Conclusions and relevanceThe prescription of oral opioid analgesics remains the common general practice approach for vertebral compression fractures management, despite the lack of evidence to support this. Clinical trials addressing management of these fractures are urgently needed to improve the quality of care patients receive.

Clinical Profiles of Osteoporotic Vertebral Compression Fractures: A Secondary Data Analysis of 358 Patients from a Prospective Clinical Study

“…Megale and colleagues [24] reported that the most common reason for driving medical care seeking behavior is surprisingly not back pain (48%) but an experience of trauma or injury (6%), a past diagnosis of fracture (6%), or a complaint of not being able to sleep. Emotionally, patients with a history of VF or VA may seek medical care once back pain is recurrent, but no correlation was found between the timing for seeking medical aid and history of VF or VA in this cohort of patients.…”

Toxicity of the acetyl‑para‑aminophenol group of medicines to intact intervertebral disc tissue cells

“…It is frequently prescribed as an analgesic and antipyretic in the treatment of headache, toothache, migraine, dysmenorrhea, myalgia, neuralgia, musculoskeletal, tonsillectomy pain, the common cold, influenza, and other bacterial and viral infections. It can also be used as a pain controller for numerous cases in neurosurgery and emergency departments, including posterior lumbar laminectomy ( 24 ), vertebral compression fractures ( 25 ), spinal primary and metastatic tumors ( 26 ), post-craniotomy in intracranial pathology surgery ( 27 ), traumatic fractures of bones ( 28 ), urinary colic ( 29 ) and acute appendicitis ( 30 ).…”

Decreased physical health-related quality of life—a persisting state for older women with clinical vertebral fracture

“…Even with such devastating numbers, many individuals with vertebral fractures continue to go unnoticed and are never diagnosed and therefore never treated, or treated too late, for the underlying osteoporosis. This might be due to diffuse and low symptom burden for the patient, making it assessed as an age-related differential diagnosis [2, 5, 13, 37].…”