From the Guidelines
Compression fractures should be initially managed with conservative treatment, including pain management with acetaminophen or NSAIDs, rest, and early mobilization with a back brace, as most patients experience spontaneous resolution of pain within 6-8 weeks 1.
Overview of Compression Fractures
Compression fractures are a type of bone break that occurs when part of a vertebra in the spine collapses. They commonly occur in older adults with osteoporosis when the vertebrae become weakened and can't withstand normal pressure.
Treatment Options
Treatment typically involves:
- Pain management with acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for mild to moderate pain
- Short-term opioids may be prescribed for severe pain
- Rest is recommended initially, but early mobilization with a back brace is important to prevent muscle weakness
- Physical therapy should begin within a few weeks to strengthen back muscles and improve posture
Minimally Invasive Procedures
For severe cases or those that don't respond to conservative measures, minimally invasive procedures like vertebroplasty or kyphoplasty may be considered, where bone cement is injected into the fractured vertebra to stabilize it 1.
Prevention
Prevention includes:
- Calcium supplementation (1000-1200mg daily)
- Vitamin D (800-1000 IU daily)
- Weight-bearing exercises
- Osteoporosis medications if indicated
Key Considerations
- Most compression fractures heal within 6-8 weeks with conservative treatment
- Vertebral body edema is not a precise measure of compression fracture age, and the duration after an osteoporotic compression fracture is often not known with certainty
- Medical management is often complementary to other treatment strategies, and medications include nonsteroidal anti-inflammatory drugs and narcotics, which should be used with caution due to associated effects 1.
From the FDA Drug Label
In the pooled analysis, patients who received alendronate sodium had a loss in stature that was statistically significantly less than was observed in those who received placebo (-3.0 mm vs. -4. 6 mm). 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. Fracture Intervention Trial: Three-Year Study (patients with at least one baseline radiographic vertebral fracture) This randomized, double-blind, placebo-controlled, 2027-patient study (alendronate sodium, n=1022; placebo, n=1005) demonstrated that treatment with alendronate sodium resulted in statistically significant reductions in fracture incidence at three years as shown in Table 6 Table 6: Effect of Alendronate Sodium on Fracture Incidence in the Three-Year Study of FIT (patients with vertebral fracture at baseline)
- Number evaluable for vertebral fractures: Alendronate sodium, n=984; placebo, n=966 † p<0.001, ‡ p=0.007, § p<0.01, ¶ p<0. 05 Percent of Patients Alendronate Sodium(n=1022) Placebo(n=1005) Absolute Reduction in Fracture Incidence Relative Reduction in Fracture Risk % Patients with: Vertebral fractures (diagnosed by X-ray)* ≥1 new vertebral fracture 7.9 15.0 7.1 47† ≥2 new vertebral fractures 0.5 4.9 4.4 90†
Compression fracture reduction was observed with alendronate sodium treatment.
- The relative risk reduction in patients with at least one new vertebral fracture was 47% in the Three-Year Study of FIT.
- The relative risk reduction in patients with at least two new vertebral fractures was 90% in the Three-Year Study of FIT.
- Alendronate sodium treatment resulted in a statistically significant reduction in the proportion of patients experiencing one or more new vertebral fractures relative to those treated with placebo (3.2% vs. 6.2%; a 48% relative risk reduction). 2
From the Research
Definition and Prevalence of Compression Fracture
- Vertebral compression fractures are a prevalent disease affecting osteoporotic patients, causing significant pain and loss of function 3.
- They are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States 4, 5.
- Vertebral compression fractures affect at least one-fourth of all postmenopausal women, with the most significant risk factor being osteoporosis 6.
Diagnosis of Compression Fracture
- Diagnosis involves a clinical history focusing on the nature of the patient's pain as well as various imaging studies, including plain radiographs, computed tomography, and magnetic resonance imaging 3, 4.
- Magnetic resonance imaging is the modality of choice to determine if the fracture is acute vs chronic in nature 4.
Management of Compression Fracture
- Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing 3.
- Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty 3, 4, 5.
- Nonsurgical management of the spinal fracture should focus on pain control and maximizing functional outcome, while surgical treatment remains controversial and should be reserved for patients who fail initial nonsurgical management options 6.
Treatment Options
- Analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin may be used to treat acute vertebral compression fractures 5.
- Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections 5.
- Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life 5.