What is the cause of anterior wedging of vertebrae?

From the Guidelines

Anterior wedging of vertebrae is a condition that requires prompt evaluation and management to prevent further bone loss and reduce the risk of fractures, with the most recent guidelines recommending osteoporosis screening and treatment with bisphosphonates like alendronate (70mg once weekly) or zoledronic acid (5mg IV yearly) for osteoporotic cases 1. The condition can occur due to various causes including osteoporosis, trauma, compression fractures, or developmental issues.

• Treatment depends on the underlying cause and severity, with mild to moderate cases managed conservatively using pain medication (acetaminophen or NSAIDs like ibuprofen 400-800mg three times daily), physical therapy to strengthen supporting muscles, and possibly bracing.
• For osteoporotic wedging, bisphosphonates may be prescribed to prevent further bone loss, as recommended by the American College of Radiology Appropriateness Criteria for osteoporosis and bone mineral density 1.
• Severe cases with significant pain or neurological symptoms might require vertebroplasty or kyphoplasty, where bone cement is injected into the vertebra to stabilize it, as outlined in the ACR Appropriateness Criteria for management of vertebral compression fractures 1. The condition can lead to kyphosis (forward curvature of the spine) if multiple vertebrae are affected, potentially causing chronic pain and respiratory issues.
• Regular follow-up with imaging is important to monitor progression, especially in osteoporotic patients, with the use of DXA or QCT scans to assess bone mineral density and vertebral body compression 1.
• Weight-bearing exercises and adequate calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) intake are recommended for prevention, as suggested by the National Osteoporosis Foundation and the American Association of Clinical Endocrinologists 1.

From the Research

Anterior Wedging of Vertebrae

• Anterior wedging of vertebrae is a condition where the vertebrae become deformed, leading to a wedge-shaped appearance, which can cause senile kyphosis 2.
• This deformity can arise with minimal trauma and is difficult to reproduce in cadaveric spines, but it is believed to be created by a 2-stage process involving initial endplate damage, followed by progressive collapse of the anterior cortex 2.
• The condition is often associated with osteoporosis, and the treatment options include orthotic methods, such as braces, as well as surgical intervention, including vertebroplasty and kyphoplasty 3, 4, 5.

Causes and Risk Factors

• The exact cause of anterior wedging of vertebrae is unknown, but it is believed to be related to excessive loading on the vertebral endplate, which can damage the endplate and lead to decompression of the adjacent intervertebral disc 2.
• Osteoporosis is a significant risk factor for vertebral compression fractures, which can result in anterior wedging of vertebrae 4.
• Age is also a risk factor, as the incidence of vertebral compression fractures increases with age 4.

Treatment Options

• Orthotic methods, such as braces, can be used to treat anterior wedging of vertebrae, especially in cases where surgery is not possible 3.
• Surgical intervention, including vertebroplasty and kyphoplasty, can be used to stabilize the vertebrae and provide pain relief 4, 5.
• Percutaneous vertebral augmentation is a minimally invasive procedure that can be used to treat vertebral compression fractures, including those that result in anterior wedging of vertebrae 4.