Management of Vertebral Fractures

Initial Treatment

The American College of Radiology recommends initial treatment should focus on pain control with appropriate analgesics, including acetaminophen, NSAIDs, and if necessary, short-term narcotic medications 2
Limited bed rest (avoiding prolonged immobilization) is recommended as prolonged bed rest can lead to rapid bone loss, muscle strength decline, and increased risk of complications such as decubitus ulcers and deep vein thrombosis 1
Early mobilization should be encouraged as tolerated to prevent complications of immobility 1, 3

An appropriate rehabilitation program should include early post-fracture physical training and muscle strengthening 4, 5
Long-term continuation of balance training and multidimensional fall prevention is essential 4, 5
Early identification of individual goals and needs is crucial before developing the rehabilitation plan 4, 5

Calcium supplementation (1000-1200 mg/day) and vitamin D (800 IU/day) are recommended 4, 5, 6
Bisphosphonates (alendronate, risedronate) are first-choice agents for preventing subsequent fractures 4, 5
For patients with oral intolerance, dementia, malabsorption, or non-compliance, zoledronic acid (intravenous) or denosumab (subcutaneous) are alternatives 4, 5

Patient education about the burden of the disease, risk factors for fractures, follow-up, and duration of therapy is essential 3
Non-pharmacological measures include smoking cessation, limiting alcohol intake, and fall prevention strategies 4, 5, 6
Regular monitoring for medication tolerance and adherence is important for long-term success 4, 5

For pathologic vertebral fractures due to malignancy, a multidisciplinary approach including interventional radiology, surgery, and radiation oncology consultation is recommended 7, 8
In cases of neurological deficits, spinal instability, or cord compression, surgical consultation is necessary 2, 8
Orthogeriatric co-management is recommended for frail elderly patients with multiple comorbidities and polypharmacy 3

Prolonged bed rest leading to deconditioning, bone loss, and increased risk of complications 1
Inadequate pain control leading to immobility and further complications 2
Failure to address underlying osteoporosis, increasing risk of subsequent fractures 4, 5
Delaying vertebral augmentation in appropriate candidates with persistent pain 2
Not considering pathologic fractures that may require different management approaches 7, 8