From the Guidelines
The most effective management option for a compression fracture is a multimodal approach, including pain management, activity modification, bracing, physical therapy, and consideration of minimally invasive procedures such as vertebroplasty or kyphoplasty for patients with persistent pain despite conservative treatment, as supported by the most recent and highest quality study 1.
Initial Treatment
Initial treatment typically involves pain management with acetaminophen (500-1000mg every 6 hours), NSAIDs like ibuprofen (400-800mg three times daily), or if needed, short-term opioids such as hydrocodone/acetaminophen (5/325mg every 4-6 hours) for severe pain. Activity modification is essential, with a gradual return to normal activities as tolerated, but avoiding heavy lifting and high-impact exercises for 6-12 weeks.
Conservative Management
Conservative management includes medical management with or without methods of immobility, and is the initial treatment of painful VCFs 1. Bracing with a thoracolumbar orthosis may be recommended for 6-12 weeks to provide support and limit painful movements. Physical therapy should be initiated within 1-2 weeks to strengthen core and back muscles, improve posture, and enhance mobility.
Minimally Invasive Procedures
Minimally invasive procedures such as vertebroplasty or kyphoplasty may be considered for patients with persistent pain despite 4-6 weeks of conservative treatment. These procedures involve injecting bone cement into the fractured vertebra to stabilize it and potentially restore height. Kyphoplasty has been shown to be effective in treating symptomatic vertebral compression fractures, with advantages including immediate pain relief, avoiding delays in chemoradiation, outpatient care, biopsy of tissue, vertebral height restoration, and potential antitumor effect of bone cement 1.
Surgery
Surgery is typically reserved for cases with neurological compromise, spinal instability, or significant deformity. The treatment approach should be tailored to the individual patient based on their age, overall health, activity level, and the specific characteristics of the fracture.
Prevention of Future Fractures
For patients with osteoporosis, medications like bisphosphonates (alendronate 70mg weekly), calcium supplements (1000-1200mg daily), and vitamin D (800-1000 IU daily) are important to prevent future fractures.
Key points to consider in management:
- Pain management is crucial in the initial treatment phase
- Activity modification and bracing can help in reducing pain and preventing further injury
- Minimally invasive procedures like vertebroplasty or kyphoplasty can be considered for persistent pain
- Surgery is reserved for severe cases with neurological compromise or instability
- Prevention of future fractures is important in patients with osteoporosis, through medications and supplements.
From the FDA Drug Label
In postmenopausal women, alendronate sodium tablets, USP increase bone mass and reduce the incidence of fractures, including those of the hip and spine (vertebral compression fractures). The management options for a compression fracture include treatment with alendronate sodium, which has been shown to reduce the incidence of vertebral fractures in postmenopausal women with osteoporosis 2.
- Key benefits of alendronate sodium include:
- Reduction in the incidence of vertebral fractures
- Increase in bone mass
- Reduction in the risk of hip fractures The use of alendronate sodium for the treatment of osteoporosis is based on clinical data of four years duration, and the optimal duration of use has not been determined 2.
From the Research
Management Options for Compression Fractures
- Conservative management is often the first choice for managing stable osteoporotic vertebral compression fractures, involving a combination of medications, bracing, and physical therapy 3
- Treatment options may also include epidural steroid injections for radicular pain and vertebral augmentation for some patients 3
- Calcitonin (FORTICAL, MIACALCIN) has been explored as a possible option for minimizing pain and reducing disease progression in osteoporotic vertebral compression fractures 4
- Analgesic medications, such as NSAIDs and biphosphonates, are commonly used to address chronic pain, while surgical interventions like balloon kyphoplasty and vertebroplasty are typically reserved for patients who have failed other methods 4
Surgical Interventions
- Kyphoplasty is a treatment option for osteoporotic vertebral compression fractures, which reduces the fracture and stabilizes it with cement 5
- Vertebroplasty is another surgical technique that helps decrease pain and improve function in fractured vertebrae 6
- Both kyphoplasty and vertebroplasty have been shown to be safe and effective, with high acceptance and use rates, and significant improvement in pain and function following treatment 6
Conservative Treatment
- Spinal orthoses have been shown to provide significantly higher medium-term pain relief and disability reduction compared to no intervention 7
- Analgesic medications, such as diclofenac and tramadol, have been demonstrated to have immediate- and short-term pain effects, although the evidence is limited and of low quality 7
- Large, multinational, placebo/sham-controlled trials are needed to address the gap in evidence for conservative care for acute pain related to vertebral compression fractures 7