Management of Osteoporotic Compression Fractures

Initial Management (Acute Phase: 0-5 days)

The American Academy of Orthopaedic Surgeons recommends calcitonin therapy for patients presenting with an acute osteoporotic spinal compression fracture (0-5 days after injury or symptom onset) who are neurologically intact 1, 2, 3
Nasal calcitonin (200 IU) or calcitonin suppositories (200 IU) have been shown to reduce pain at 1, 2, 3, and 4 weeks in a clinically significant manner 2, 3
Side effects of calcitonin are generally mild and may include dizziness 3

For persistent pain at L3 or L4 vertebral compression fractures, an L2 nerve root block is a treatment option 4, 5
Bracing has insufficient evidence to make a strong recommendation, as studies have not adequately reported age or fracture level 4
Exercise programs (supervised or unsupervised) have inconclusive evidence for efficacy 4, 6

Ibandronate and strontium ranelate are recommended options to prevent additional symptomatic fractures in patients with existing vertebral compression fractures 4, 6

The American Academy of Orthopaedic Surgeons makes a strong recommendation against vertebroplasty for treating osteoporotic compression fractures 1
Kyphoplasty may be considered as a weak recommendation for symptomatic fractures in neurologically intact patients 1

For compression fractures at L3 or L4 levels, referred abdominal pain may occur due to involvement of the L2 nerve root 5