Management of Osteoporotic Vertebral Compression Fractures

Immediate Fracture Management

The American College of Radiology recommends avoiding prolonged bed rest, as this accelerates bone loss, muscle weakness, and increases risk of deep venous thrombosis and pressure ulcers 1, 2
Gentle range-of-motion exercises should be begun within the first few days, focusing on maintaining mobility while avoiding activities that increase spinal flexion 3
Acetaminophen should be initiated as first-line analgesia, avoiding NSAIDs given the patient's age and potential cardiovascular/renal comorbidities 1, 2

The American College of Radiology suggests that MRI is required to distinguish acute from chronic fractures, as this determines treatment urgency and candidacy for vertebral augmentation 4
DXA scanning of lumbar spine and hip should be ordered to quantify bone mineral density and establish baseline T-scores 1, 2
Laboratory workup including serum calcium, albumin, creatinine, thyroid-stimulating hormone, and ESR should be obtained to identify secondary causes of osteoporosis 2

The National Osteoporosis Foundation recommends initiating oral bisphosphonate therapy (alendronate 70 mg weekly or risedronate 35 mg weekly) immediately, which reduces vertebral fractures by 47-48%, non-vertebral fractures by 26-53%, and hip fractures by 51% 1
Calcium 1000-1200 mg/day (diet plus supplementation as needed) and vitamin D 800 IU/day should be prescribed, which reduces non-vertebral fractures by 15-20% and falls by 20% 1, 3, 5

The American Geriatrics Society recommends implementing early postfracture physical training focusing on muscle strengthening and balance training 3, 6
Comprehensive fall prevention strategies should be implemented, which reduce fall frequency by approximately 20% 1
Weight-bearing exercises should be prescribed as tolerated to improve bone mineral density and muscle strength 1, 5

Patients should be educated about osteoporosis burden, fracture risk factors, importance of medication adherence, and expected duration of therapy 3, 5
Smoking cessation and limiting alcohol intake should be recommended, as these negatively affect bone mineral density, bone quality, and fall risk 3, 5

Collaboration between primary care, orthopedics, rheumatology/endocrinology, and physical therapy is essential for optimal outcomes 1, 3, 7
Consider orthogeriatric co-management if the patient has multiple comorbidities and polypharmacy 1, 3

Systematic follow-up with regular monitoring for medication tolerance and adherence should be established 1
Fracture risk should be reassessed every 1-3 years with repeat DXA scanning, performing earlier reassessment (within 1 year) given this patient's fragility fracture history 2