Treatment of Osteopenia and Atraumatic Vertebral Compression Fractures
Initial Management Approach
- Medical management is the standard initial approach for patients with osteoporotic vertebral compression fractures without neurological deficits, as recommended by the American College of Radiology 1, 4
- The natural history of most healing vertebral compression fractures (VCFs) is gradual improvement in pain over 2 to 12 weeks, with variable return of function 3
Pharmacological Management
- Calcitonin may be considered for acute pain management in the first 4 weeks after fracture identification, according to the American Academy of Orthopaedic Surgeons 5
When to Consider Advanced Interventions
- If there is failure of medical management with worsening symptoms after 3 months, vertebral augmentation (VA) procedures should be considered, as recommended by the American College of Radiology 2, 3
- Indications for earlier intervention include spinal deformity, worsening symptoms despite medications, and pulmonary dysfunction, as indicated by the American College of Radiology 2, 3
Vertebral Augmentation Options
- Vertebroplasty (VP) and balloon kyphoplasty (BK) are the main vertebral augmentation procedures, which have shown immediate and considerable improvement in pain and patient mobility, according to the American College of Radiology 2, 3
- Balloon kyphoplasty may provide better improvement in spinal deformity with extension of the kyphotic angle and increased vertebral body height, as reported by the American College of Radiology 3
Special Considerations
- The age of the fracture does not independently affect the outcomes of vertebroplasty, with evidence supporting treatment of subacute and chronic painful compression fractures, as stated by the American College of Radiology 3
Surgical Management
- Surgical intervention is only indicated for vertebral compression fractures complicated by spinal instability, neurological deficits, or significant spinal cord compression, according to Praxis Medical Insights 6