From the Guidelines
The recommended plan of care for a compression fracture is conservative management with medical management, including pain control and activity modification, as the initial treatment, with consideration of Percutaneous Vertebral Augmentation (VA) for osteoporotic VCFs that do not respond to conservative therapy. This approach is supported by the American College of Radiology's appropriateness criteria for managing vertebral compression fractures 1.
Medical Management
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 1. Conservative management includes medical management with or without methods of immobility and is the initial treatment of painful VCFs. Pain control with medications such as acetaminophen or NSAIDs is appropriate, with short-term opioids sometimes needed for severe pain.
Percutaneous Vertebral Augmentation (VA)
VA may be a treatment option for osteoporotic VCFs, as there is evidence that VA is associated with better pain relief and improved functional outcomes compared to conservative therapy 1. The timing of when VA is appropriate has been debated, but studies have found VA to be superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks’ duration.
Comparison of VA Techniques
Many studies have compared Vertebroplasty (VP) versus Kyphoplasty (BK), with findings suggesting that VP and BK are equally effective in substantially reducing pain and disability in such patients 1. However, some studies have shown that BK may provide superior functional recovery compared with VP due to improvements in spinal deformity and less cement leakage.
Treatment Considerations
In scenarios when a patient with a painful osteoporotic VCF cannot undergo VA or surgery, medical management is the main treatment option. The goal of treatment is to alleviate pain, improve function, and prevent further complications. Regular follow-up is essential to monitor healing and adjust treatment as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Plan of Care for Compression Fracture
The recommended plan of care for a compression fracture typically involves a multimodal approach, including:
- Conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing 2, 3
- Nonsurgical modalities such as medications, bracing, and physical therapy 3
- Vertebral augmentation through either vertebroplasty or kyphoplasty for patients who are refractory to conservative management 2, 3, 4
Treatment Options
Treatment options for compression fractures include:
- Medical management, including nonsteroidal anti-inflammatory drugs, calcitonin, teriparatide, and bisphosphonates 5
- Vertebral augmentation, especially balloon-assisted kyphoplasty, which has the potential to dramatically reduce pain and improve quality of life 5
- Bracing, which may be safe and improve pain and disability, although the evidence is limited and variable 6
- Kyphoplasty, which may be of benefit for select patients compared to bracing alone 6
Diagnosis and Evaluation
Diagnosis and evaluation of compression fractures involve: