Current Evidence for Conservative Management of Osteoporotic Vertebral Fractures
Keywords:
Conservative treatment, osteoporotic vertebral fracture, OVCFAbstract
Conservative treatment is the mainstay for osteoporotic vertebral fractures in patients without indications for surgery. However, evidence from clinical practice remains inconclusive. This article aimed to collect current evidences relevant to conservative treatment approaches. We conducted a comprehensive search for high-quality evidences published between 2010 and the present in top-tier journals in order to discuss issues related to the details of each treatment protocol. Bed-rest has been shown effectiveness in controlling pain and reducing the progression of vertebral collapse and kyphosis, especially among patients with poor prognostic MRI findings. However, determining the appropriate duration of bed-rest remains a subject of debate. It should be evaluated on a case-by-case basis, with the goal of providing sufficient pain control while minimizing the risk of complications from prolonged immobilization. Bracing has shown positive clinical outcomes and safety. Evidence showed that bracing improved spinal stability, muscular strength, and functional outcomes. Although routine bracing is not generally recommended, it may be considered for certain patients depending on individual circumstances. Specific radiographic and MRI findings have been associated with conservative treatment failure, such as the progression of collapse, pseudarthrosis, kyphotic deformity, and neurologic impairment. Clinicians should be aware of identifying these factors and may opt for more aggressive treatments when monitoring patients with such factors. The evidence from clinical practice regarding the conservative treatment of osteoporotic vertebral fractures is inconclusive. Nonetheless, the treatment objective is to alleviate pain, improve quality of life, and reduce disability. Effective management can ensure that patients receive the most appropriate treatment with maximum efficiency and safety.
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