Osteoporosis induced compression fractures commonly present as significant upper back pain in our older patient population. Risk factors includes history of osteoporosis, minor trauma, localized pain to the upper and mid back. Pain can be debilitating, resulting in an emergency room visit. If there is strong clinical suspicion of a compression fracture, x-rays of the thoracic and lumbar spine are indicated. In patients without neurologic deficit, and no neoplasm history, further diagnostic testing such as MRI, or CT scan usually is not immediately necessary.
Treatment options include judicious use of narcotic medications, lumbar corset for comfort, and physical therapy including ambulation training.
Recently, the use of the surgical techniques of vertebroplasty, and kyphoplasty have been studied. In patients with a tolerable level of pain, current recommendations are to limit the use of technique on patient with continued pain after 4-6 weeks of conservative care. Long-term data on these technique did not show any measurable difference compared to noninvasive treatments.
In the short term, while there may be patients who gained immediate pain relief, this must be weighed against potential risks of an invasive procedure.
The best long-term approach to osteoporosis induced compression fractures are to treat the osteoporosis, and a promote physical conditioning. Unfortunately, these fractures are often associated with significant medical comorbidities. Oftentimes, the only treatment is palliative pain management.
Patient physiology may determine the long-term outcome.
Last modified: February 13, 2021