Appropriateness criteria for treatment of osteoporotic vertebral compression fractures

Abstract

The purpose of this study was to review and summarise the literature on appropriateness criteria for treatment of osteoporotic vertebral compression fractures (OVCF), with appropriateness defined as a treatment where the expected benefits outweigh the expected harms, confirmed by available evidence and expert opinion. A comprehensive search of peer-reviewed publications (PubMed, EMBASE) and grey literature was performed. To be included for analysis, documents had to be a review article (e.g. clinical guideline or meta-analysis), focus on OVCF and make a statement on treatment appropriateness. Eleven publications fulfilled the eligibility criteria. Among the five publications that made recommendations about non-surgical management (NSM), there is agreement that conservative methods are appropriate in OVCF patients who have low level of pain, and that the majority of patients should be treated with conservative methods before other treatments are initiated. All publications made recommendations about vertebral augmentation procedures (VAP), i.e. vertebroplasty (VP) and/or balloon kyphoplasty (BKP). VAP are mostly considered appropriate in patients with high level of pain who do not respond to NSM. However, results cannot be generalised due to heterogeneity of treatment recommendations and patient selection. Although there is a consensus that NSM should be considered as the first-line treatment, there is more heterogeneity in treatment recommendations for VAP. This could most likely be explained by an insufficient clinical evidence base for VAP and heterogeneity of OVCF patients, leading to greater reliance on expert opinion affecting the quality of evidence in the primary sources.

Bilateral Acute Osteoporotic Lumbar Pedicle Fracture Presenting with Associated Neurological Deficit: A Case Report and Review of Literature

“…Vertebral body compression fractures are a frequent cause of neurosurgical consultation in the elderly population, particularly post-menopausal women [4,5]. The most common presenting symptom is pain.…”

“…Most fractures can be treated non-surgically including pain medication, modification of activity and bracing [4]. For patients in whom mobilization is limited due to severe pain, even after bracing, a vertebroplasty or balloon kyphoplasty can be considered [5]. Surgical intervention is reserved for patients with continued fracture collapse, instability, and neural compromise.…”

Gait in patients with symptomatic osteoporotic vertebral compression fractures over 6 months of recovery

“…healing of the fracture [2]. However, up to one-third of patients experience incapacitating pain for months to years due to insufficient response to treatment [2,7].…”

“…One of the most common fractures among older adults is osteoporotic vertebral compression fractures (OVCFs), with an estimated 500,000 new fractures occurring every year in Europe [1,2]. After an OVCF, there is disproportionate height loss from the anterior vertebral body resulting in a wedge-shaped vertebra [3].…”

<p>The Application of Vertebral Augmentation Procedures and Teriparatide in the Treatment of Osteoporotic Vertebral Compression Fractures [Response to Letter]</p>

“…Short-term (eg pain relief, restoration of mechanical stability, mobility improvement and fracture healing) and long-term achievements (eg progressive QOL improvement and prevention of NVCFs) need to be realized in strategies for patients who suffered osteoporotic vertebral compression fractures (OVCFs). 2,3 Vertebral augmentation procedures (VAP), ie percutaneous vertebroplasty (PVP) and/or PKP, is a minimally invasive therapy adopted in the treatment of OVCFs with the aim of prior pain alleviation by stabilizing the vertebral fracture and recovery of function by restoring vertebral body height (VBH). 4 Literature reported that PVP/PKP quickly restored patients' walking ability soon after operation and improved QOL in the early stage of OVCFs.…”