Patel D, Liu J, Ebraheim NA. Managements of osteoporotic vertebral compression fractures: A narrative review. World J Orthop 2022; 13(6): 564-573 [PMID: 35949707 DOI: 10.5312/wjo.v13.i6.564]
Corresponding Author of This Article
Jiayong Liu, MD, Associate Professor, Department of Orthopedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States. jiayong.liu@utoledo.edu
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jun 18, 2022; 13(6): 564-573 Published online Jun 18, 2022. doi: 10.5312/wjo.v13.i6.564
Managements of osteoporotic vertebral compression fractures: A narrative review
Devon Patel, Jiayong Liu, Nabil A Ebraheim
Devon Patel, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, United States
Jiayong Liu, Nabil A Ebraheim, Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: Liu J and Ebraheim NA designed the research study; Patel D performed the data collection; Patel D, Liu J, and Ebraheim NA analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest in creating and publishing this manuscript and received no funding to assist in its completion.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiayong Liu, MD, Associate Professor, Department of Orthopedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States. jiayong.liu@utoledo.edu
Received: February 28, 2022 Peer-review started: February 28, 2022 First decision: April 13, 2022 Revised: April 26, 2022 Accepted: June 14, 2022 Article in press: June 14, 2022 Published online: June 18, 2022 Processing time: 108 Days and 7 Hours
Abstract
Osteoporotic vertebral compression fractures (OVCFs) are the most common fragility fracture and significantly influence the quality of life in the elderly. Currently, the literature lacks a comprehensive narrative review of the management of OVCFs. The purpose of this study is to review background information, diagnosis, and surgical and non-surgical management of the OVCFs. A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed. Combinations of the following terms were used: compression fractures, vertebral compression fractures, osteoporosis, osteoporotic compression fractures, vertebroplasty, kyphoplasty, bisphosphonates, calcitonin, and osteoporosis treatments. Additional articles were also included by examining the reference list of articles found in the search. OVCFs, especially those that occur over long periods, can be asymptomatic. Symptoms of acute OVCFs include pain localized to the mid-line spine, a loss in height, and decreased mobility. The primary treatment regimens are pain control, medication management, vertebral augmentation, and anterior or posterior decompression and reconstructions. Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain. Bisphosphonates and denosumab are the first-line treatments for osteoporosis. Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief. Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications. Calcium and vitamin D supplementation can have a protective and therapeutic effect. Management of OVCFs must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present. The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
Core Tip: Management of osteoporotic vertebral compression fractures must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.
