From the Guidelines
Treatment for compression fractures typically involves a combination of pain management, rest, bracing, and in some cases, surgical intervention, with a focus on improving quality of life and reducing morbidity and mortality. Initially, pain control is achieved with acetaminophen (500-1000mg every 6 hours), NSAIDs like ibuprofen (400-800mg three times daily), or if needed, short-term opioid medications 1. Bed rest should be limited to a few days to prevent complications like blood clots and muscle weakness. A back brace may be recommended for 6-12 weeks to stabilize the spine and reduce pain during healing.
Key Considerations
- Physical therapy should begin once acute pain subsides, focusing on core strengthening and proper body mechanics.
- For severe cases or those with neurological symptoms, minimally invasive procedures like vertebroplasty or kyphoplasty may be necessary, where bone cement is injected into the fractured vertebra to stabilize it and potentially restore height 1.
- Osteoporosis medications such as bisphosphonates may be prescribed if the fracture resulted from bone weakness.
- The treatment approach varies based on fracture severity, patient age, overall health, and whether osteoporosis is present.
Medical Management
Medical management is often complementary to other treatment strategies, and medications include nonsteroidal anti-inflammatory drugs and narcotics 1. However, narcotics have to be used with caution given the associated effects of sedation, nausea, further decrease in physical conditioning, and fall risks.
Surgical Intervention
Percutaneous Vertebral Augmentation (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.
Outcome
Most compression fractures heal within 6-8 weeks with conservative treatment, though complete recovery may take 3-4 months 1. The goal of treatment is to improve quality of life, reduce morbidity and mortality, and prevent complications such as deep venous thrombosis and pulmonary embolism.
From the FDA Drug Label
The Fracture Intervention Trial (FIT) consisted of two studies in postmenopausal women: the Three-Year Study of patients who had at least one baseline radiographic vertebral fracture and the Four-Year Study of patients with low bone mass but without a baseline vertebral fracture.
In the Three-Year Study of FIT, alendronate sodium reduced the percentage of women experiencing at least one new radiographic vertebral fracture from 15.0% to 7.9% (47% relative risk reduction, p<0.001);
Alendronate sodium reduced the percentage of women experiencing multiple (two or more) new vertebral fractures from 4.2% to 0.6% (87% relative risk reduction, p<0.001) in the combined U.S./Multinational studies
The treatment for compression fractures is alendronate sodium, which has been shown to reduce the incidence of new vertebral fractures in postmenopausal women with osteoporosis.
- Key benefits of alendronate sodium include:
- Reduction in the percentage of women experiencing at least one new radiographic vertebral fracture
- Reduction in the percentage of women experiencing multiple new vertebral fractures
- Statistically significant reductions in fracture incidence at three years
- Studies have demonstrated the efficacy of alendronate sodium in reducing fracture risk, including the Fracture Intervention Trial (FIT) 2, 2.
From the Research
Treatment Options for Compression Fractures
- Conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing is the initial management approach for compression fractures 3
- Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty 3, 4, 5, 6, 7
- Medical management, including nonsteroidal anti-inflammatory drugs, calcitonin, teriparatide, and bisphosphonates, remains the first-line therapy for patients with compression fractures 4, 5
- Vertebral augmentation, especially balloon-assisted kyphoplasty, has the potential to dramatically reduce pain and improve quality of life in patients with compression fractures 4, 6
- Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain 5
- Bisphosphonates and denosumab are the first-line treatments for osteoporosis in patients with compression fractures 5
- Calcium and vitamin D supplementation can have a protective and therapeutic effect in patients with compression fractures 5
Surgical Interventions
- Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief 3, 4, 5, 6, 7
- Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications 5
- Balloon kyphoplasty had significantly better pain reduction compared with non-surgical management, and tended to have better height restoration than vertebroplasty 6
- Posterior decompression and fixation or anterior decompression and reconstruction may be required if neurological deficits are present 5