What is the treatment for a compression fracture, particularly in the spine?

From the Guidelines

Treatment for a compression fracture, particularly in the spine, should prioritize conservative management over vertebroplasty for patients who are neurologically intact, as evidenced by the lack of benefit in pain and function from vertebroplasty compared to a sham procedure 1. This approach is based on the strongest and most recent evidence available, which suggests that vertebroplasty does not offer significant advantages over conservative treatment for osteoporotic spinal compression fractures in terms of pain and function. Key components of conservative management include:

• Pain control with medications such as acetaminophen, NSAIDs (e.g., ibuprofen 400-800mg every 6-8 hours), or short-term opioids for severe pain
• Initial rest followed by gradual increase in activity to prevent muscle weakness
• Use of a back brace for 6-12 weeks to stabilize the spine and reduce pain during healing
• Physical therapy to strengthen core muscles and improve posture, typically started after the acute pain subsides (usually within 2-3 weeks) Most compression fractures heal within 6-8 weeks with conservative treatment. For cases that do not respond to conservative measures, or when there are complications such as spinal cord compression or significant instability, minimally invasive procedures like kyphoplasty or surgery may be considered. Long-term management should also focus on addressing underlying causes, such as osteoporosis, with medications like bisphosphonates, and supplements including calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) to prevent future fractures.

From the FDA Drug Label

1.1 Treatment of Osteoporosis in Postmenopausal Women Alendronate sodium tablets, USP are indicated for the treatment of osteoporosis in postmenopausal women. 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).

14.1 Treatment of Osteoporosis in Postmenopausal Women Daily Dosing The efficacy of alendronate sodium 10 mg daily was assessed in four clinical trials. ... To assess the effects of alendronate sodium on the incidence of vertebral fractures (detected by digitized radiography; approximately one third of these were clinically symptomatic), the U. S. and Multinational studies were combined in an analysis that compared placebo to the pooled dosage groups of alendronate sodium (5 or 10 mg for three years or 20 mg for two years followed by 5 mg for one year) There was a statistically significant reduction in the proportion of patients treated with alendronate sodium experiencing one or more new vertebral fractures relative to those treated with placebo (3.2% vs. 6.2%; a 48% relative risk reduction).

The treatment for a compression fracture, particularly in the spine, includes alendronate sodium which has been shown to increase bone mass and reduce the incidence of fractures, including those of the hip and spine (vertebral compression fractures) 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
• Important considerations: The optimal duration of use has not been determined, and the need for continued therapy should be re-evaluated on a periodic basis 2.

From the Research

Treatment Options for Compression Fractures

• Compression fractures, particularly in the spine, can be treated with various methods, including non-surgical and surgical options 3, 4, 5, 6, 7.
• Non-surgical management includes pain control, medication management, and bracing, with the goal of maximizing functional outcome 6, 7.
• Surgical options, such as vertebroplasty and kyphoplasty, are minimally invasive procedures that involve injecting cement into the fractured vertebra to stabilize and strengthen the bone 3, 4, 5.
• Vertebroplasty and kyphoplasty have been shown to be effective in reducing pain and improving mobility in patients with vertebral compression fractures 3, 4, 5.
• Kyphoplasty has the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease pulmonary, GI, and early morbidity consequences related to these fractures 3.

Comparison of Vertebroplasty and Kyphoplasty

• Both vertebroplasty and kyphoplasty have been shown to be safe and effective in treating painful osteoporotic vertebral compression fractures 3, 4, 5.
• A study comparing the two procedures found no significant differences in terms of pain relief and functional improvement, but noted that cement leakage occurred only during vertebroplasty 4.
• Kyphoplasty may offer the additional advantage of improving height of the fractured vertebra and reducing kyphosis, but both procedures are technically demanding 3.

Management of Osteoporotic Vertebral Compression Fractures

• Management of osteoporotic vertebral compression fractures should be combined with multiple approaches, including pain control, medication management, and vertebral augmentation 6.
• Appropriate exercises and activity modification are important in fracture prevention, and medication with different mechanisms of action is a critical long-term causal treatment strategy 6.
• Minimally invasive surgical interventions, such as vertebroplasty and kyphoplasty, are reserved for patients who have not found symptomatic relief through conservative methods and are recognized as efficient stopgap treatment methods 6.