vertebral compression fracture
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Etiology
* vertebral compression fracture makes a clinical diagnosis of osteoporosis regardless of T-score from bone mineral density measurement[7]
Clinical manifestations
- lower thoracic or lumbar spine
- abrupt onset of severe pain
- pain worsens with sitting or standing*
- pain sometimes relieved by lying down
- point tenderness over the spine at the fracture site
- absence of any neurologic abnormalities
* symptoms less position dependent than with spinal stenosis[7]
Complications
- nerve compression & radiculopathy[7]
- vertebral augmentation (vertebroplasty or kyphoplasty) not associated with secondary fracture (but of questionable value)[13]
Differential diagnosis
- ischiogluteal bursitis
- pain relieved by standing & walking
Management
- bedrest, analgesia, & mobilization as tolerated
- patients with severe pain may benefit from 2 weesk of bedrest[12]
- acetaminophen is 1st line[14]
- use NSAIDs cautiously in elderly with adequate renal function & low risk of upper GI bleed[14]
- opiates if other options fail[14]
- cibacalcin (calcitonin) may diminish pain
- pamidronate 30 mg IV QD for 3 days may diminish pain[4]
- hospitalization maybe required to control pain[4]
- pain generally improves over several weeks
- treatment for osteoporosis indicated[7]
- bisphosponate contraindicated with renal failure (eGFR < 35 ml/min)
- denosumab may be alternative in patients with renal impairment
- percutaneous vertebroplasty
- kyphoplasty unproven[4]
- back braces are ineffective[6]
- they may be cumbersome & can irritate the skin
- physical therapy for chronic back pain
More general terms
Additional terms
References
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Kao D, UCLA Multicampus Program in Geriatric Medicine & Gerontlology 2001
- ↑ Jump up to: 3.0 3.1 Staples MP et al Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: Meta-analysis. BMJ 2011 Jul 12; 343:d395 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21750078
Wilson DJ. Vertebroplasty for vertebral fracture: On the basis of current evidence, cannot be recommended as the first line treatment. BMJ 2011 Jul 12; 343:d3470 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21750076 - ↑ Jump up to: 4.0 4.1 4.2 4.3 4.4 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Esses SI, McGuire R, Jenkins J et al American Academy of Orthopaedic Surgeons clinical practice guideline on: the treatment of osteoporotic spinal compression fractures. J Bone Joint S
Esses SI, McGuire R, Jenkins J et al The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg. 2011 Mar;19(3):176-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21368099 - ↑ Jump up to: 6.0 6.1 Kim H-J et al. Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: A prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am 2014 Dec 3; 96:1959 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25471910 <Internet> http://jbjs.org/content/96/23/1959
- ↑ Jump up to: 7.0 7.1 7.2 7.3 7.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
- ↑ Jump up to: 8.0 8.1 Clark W, Bird P, Gonski P, Diamond TH et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): A multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016 Aug 17; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27544377
Hirsch JA, Chandra RV. Resurrection of evidence for vertebroplasty? Lancet 2016 Aug 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27544375 - ↑ Jump up to: 9.0 9.1 Firanescu CE et al Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ 2018;361:k1551 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29743284 Free full text https://www.bmj.com/content/361/bmj.k1551
Davies E No more vetebroplasty for acute vertebral compression fractures? BMJ 2018;361:k1756 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29743282 https://www.bmj.com/content/361/bmj.k1756 - ↑ Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ After the Vertebral Fracture http://www.osteo.org/newfile.asp?doc=r206i&doctitle=After+the+Vertebral+Fracture&doctype=HTML+Fact+Sheet
- ↑ Jump up to: 12.0 12.1 Funayama T et al. Therapeutic effects of conservative treatment with 2-week bed rest for osteoporotic vertebral fractures: A prospective cohort study. J Bone Joint Surg Am 2022 Oct 19; 104:1785 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36005391 https://journals.lww.com/jbjsjournal/Abstract/2022/10190/Therapeutic_Effects_of_Conservative_Treatment_with.3.aspx
- ↑ Jump up to: 13.0 13.1 Mills ES et al. Secondary fracture rate after vertebral osteoporotic compression fracture is decreased by anti-osteoporotic medication but not increased by cement augmentation. J Bone Joint Surg Am 2022 Dec 21; 104:2178 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36223482 https://journals.lww.com/jbjsjournal/Abstract/2022/12210/Secondary_Fracture_Rate_After_Vertebral.6.aspx
- ↑ Jump up to: 14.0 14.1 14.2 14.3 14.4 NEJM Knowledge+ Endocrinology