Do you need to treat a compression fracture?

Treatment of Vertebral Compression Fractures

Conservative medical management is the recommended first-line treatment for painful vertebral compression fractures (VCFs), including pain medications, limited bed rest, and bracing. 1

Initial Management Approach

Conservative treatment should be initiated for most vertebral compression fractures, especially:

• Subacute or chronic compression fractures without significant canal stenosis
• Stable isolated pedicle fractures
• Spinous process fractures
• Transverse process fractures 1

The initial management includes:

• Pain control with NSAIDs and acetaminophen as first-line analgesics
• Judicious use of narcotic medications (due to risks of sedation, falls, and physical deconditioning)
• Limited bed rest to reduce acute pain
• Bracing for comfort and stability 1, 2

When Surgery Is Indicated

Surgical intervention should be considered only in specific circumstances:

• Neural element compression with neurological deficit
• Spinal fracture causing instability
• Neural element compromise/compression
• Spinal dislocation with mechanical instability
• Displaced fracture fragment causing neural element compromise 1

Comprehensive Treatment Plan

Medication Management

• First-line analgesics: NSAIDs and acetaminophen
• Osteoporosis treatment with:
  • Bisphosphonates (e.g., alendronate) for treatment of osteoporosis in postmenopausal women, men with osteoporosis, and glucocorticoid-induced osteoporosis 1, 3
  • Calcium and vitamin D supplementation 1

Physical Interventions

• Bracing for comfort and stability
• Physical therapy focusing on:
  • Spinal stretching exercises
  • Functional restoration
  • Fall prevention strategies 1, 2, 4

Long-term Management

• Continuing ordinary activities within limits permitted by pain
• Osteoporosis management to prevent future fractures
• Regular reassessment of fracture healing and pain levels 4

Special Considerations

Vertebral Augmentation

• Consider vertebral augmentation (vertebroplasty or kyphoplasty) only for patients with persistent pain after 2 months of conservative treatment 5
• Recent evidence suggests that core decompression of the vertebral body does not demonstrate significant improvement in pain and disability compared to conventional conservative treatment 6

Monitoring and Follow-up

• All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated periodically
• Patients at low risk for fracture should be considered for drug discontinuation after 3-5 years 3

Common Pitfalls to Avoid

1. Overreliance on narcotic medications, which can lead to sedation, nausea, physical deconditioning, and increased fall risk 1

2. Rushing to surgical intervention for stable compression fractures without neurological compromise 1

3. Neglecting underlying osteoporosis treatment, which is essential for preventing additional symptomatic fractures 1, 3

4. Prolonged immobilization, which can lead to muscle deconditioning, bone loss, and other medical complications 2

5. Failing to reassess treatment efficacy and adjust management strategies accordingly 5