The clinician's guide to prevention and treatment of osteoporosis. LeBoff MS, Greenspan SL, Insogna KL, et al. The Bone Health and Osteoporosis Foundation states bracing can be used but there is no evidence that bracing improves physical function or disability. Recommendations from guidelines vary with regard to bracing. Īfter the initial short period of bed rest, mobilisation should be encouraged. Guidance for the management of symptomatic vertebral fragility fractures. For persistent severe pain, use of centrally-acting therapies including tricyclic antidepressants and gabapentin should be considered after discussion about the potential risks and benefits. Royal Osteoporosis Society. Opioids are recommended only for very short-term use with acute fractures. If used chronically, opioids lose potency, induce dependence, raise risk for addiction, and lead to falls and central sensitisation. If opioids are used, a laxative should also be prescribed and fluid intake encouraged to avoid constipation, as straining at defecation can cause further fractures. If stronger analgesia is required, opioids such as oxycodone can be used in combination with paracetamol. UK guidelines recommend to consider paracetamol ahead of oral NSAIDs, cyclo-oxygenase-2 (COX-2) inhibitors, or opioids. Royal Osteoporosis Society. NSAIDs in the older patient: balancing benefits and harms. NSAIDs should be used with caution in older people because of increased susceptibility to side effects such as gastrointestinal bleeding and cardiovascular events. Nonsteroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. Marquez-Lara A, Hutchinson ID, Nuñez F Jr, et al. The effect of nonsteroidal anti-inflammatory drugs on bone healing in humans: a qualitative, systematic review. Data from animal studies on the impairment of fracture healing by NSAIDs are inconclusive, and these agents are regularly used clinically for this indication. 2022 Oct 33(10):2049-102.Īnalgesia should begin with non-opioids such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Prolonged immobility should be avoided, as this only increases bone loss, frailty, and the risk of subsequent fractures. Most patients experience gradual improvement of pain over 6-12 weeks and are managed with analgesia and 24-48 hours of bed rest, followed by early mobilisation with continued analgesia and temporary use of a lumbosacral corset or thoracolumbar orthosis, if required. Acute isolated anterior column fractureĪlmost all osteoporotic compression fractures are of this type. The occurrence of a spinal compression fracture should also trigger a review and optimisation of treatment of the underlying osteoporosis itself. However, surgical intervention may be required for potentially unstable acute fractures or if any of the following develop: worsening pain on mobilisation, significant deformity, or neurological involvement. In most patients, experts recommend non-operative interventions combined with radiographic and clinical follow-up at 6-week intervals for 3 months from injury are sufficient. Vertebral fractures do not usually require hospitalisation. Prolonged immobility should be avoided, as this only increases bone loss and the risk of subsequent fractures. Reducing progression of existing fractures. Providing sufficient analgesia and physical support to facilitate rapid rehabilitation and return to normal activities The general aims of treatment of acute osteoporotic spinal compression fracture include:
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