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Osteoporotic vertebral fracture

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Updated Sep 2026
Illustration: spine

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang iyong nararamdaman

Ang osteoporotic fracture ay nangyayari kapag ang isang buto sa iyong spine, na tinatawag na vertebra, ay nagiging masyadong manipis at mahina kaya ito ay nagkakaroon ng lamat sa ilalim ng pang-araw-araw na load. Ang sakit ay karaniwang nasa gitna ng iyong likod o kung saan nagtatagpo ang iyong mid back at lower back. Madalas itong biglaang dumarating, kung minsan pagkatapos ng mga simpleng bagay tulad ng pagyuko, pagbuhat, o bahagyang pagkatisod.

Ang sakit ay karaniwang matalas sa simula at kalaunan ay nagiging isang dull ache. May tendensiya itong lumala kapag ikaw ay nakatayo o naglalakad nang ilang sandali, kapag ikaw ay pumipilipit, o kapag ikaw ay yumuyuko pasulong. Maaaring maging mahirap ang pag-upo mula sa pagkakahiga, at ang sakit ay madalas na sumisiklab paggising o pagkatapos mong tumayo. Ang paghiga ay maaaring makapagpagaan nito. Ang mga pang-araw-araw na gawain na nagbibigay ng load sa iyong spine ay nagiging mahirap: pagdadala ng pinamili, pagbangon mula sa mababang upuan, pag-aayos ng kama, o pag-akyat sa hagdan.

Kung ang fracture ay nakaapekto sa ibabang bahagi ng isang vertebra, maaari nitong mairita ang isang nerve na bumababa sa iyong binti. Maaari itong magdulot ng sakit, pangingilig, o pamamanhid sa binting iyon. Ang ilang tao ay nakakaranas din ng strain sa matibay na sheet ng tissue na bumabalot sa kanilang lower back muscles, na nagdaragdag sa sakit.

Ang mga fracture na ito ay maaaring makaapekto sa higit sa isang vertebra, at madali itong makaligtaan sa mga plain X-ray. Kung ikaw ay higit sa 60 taong gulang at may biglaang sakit sa likod, mahalagang maipa-check ito nang maayos. Ang fracture ay nangangahulugan din na ang iyong mga buto ay mas mahina kaysa sa dapat, kaya may tunay na posibilidad ng isa pang fracture, kabilang ang hip fracture, sa loob ng susunod na ilang taon. Ang panganib na iyon ay mas mataas muli kung nagkaroon ka na ng higit sa isang spinal fracture.

Karamihan sa mga fracture na ito ay gumagaling sa paglipas ng panahon at hindi nangangailangan ng surgery. Kung ang iyong sakit ay nananatiling malala sa kabila ng pain medication, may mga procedure na maaaring makatulong, na tatalakayin namin sa mga susunod na seksyon.

Ano ang aktwal na nangyayari

Ang iyong spine ay isang tumpok ng mga buto na tinatawag na vertebrae, at ang bawat isa ay may solidong bloke sa harap na pumapasan ng iyong timbang. Ang malusog na buto ay isang living scaffold, na patuloy na muling binubuo habang ang lumang buto ay inaalis at ang bagong buto ay inilalatag. Sa osteoporosis, nawawala ang balanseng iyon: mas mabilis na inaalis ang buto kaysa sa napapalitan ito, kaya ang scaffold ay nagiging manipis at porous, tulad ng isang honeycomb na may palaki nang palaking mga butas.

Ang harapang bloke ng bawat vertebra ay idinisenyo upang tanggapin ang compressive load ng iyong katawan, na medyo katulad ng isang brick na pumapasan ng timbang ng pader sa itaas nito. Kapag ang brick na iyon ay naging porous, ang mga pang-araw-araw na load tulad ng pagyuko o pagbuhat ay maaaring dumurog dito. Ang buto ay nag-compress at nag-wedge, kaya ang vertebra ay nawawalan ng taas sa harap at ang spine ay bahagyang yumuyuko pasulong sa antas na iyon. Ang pagkadurog na iyon ang fracture na iyong nararamdaman, at ang sakit ay nagmumula sa mismong bitak ng buto at mula sa strain na ibinibigay nito sa mga tissue sa paligid nito.

Ang mga fracture na ito ay madalas mangyari kung saan nagtatagpo ang iyong mid back at lower back, dahil ang junction na iyon ang tumatanggap ng mas maraming bending forces sa iyong spine. Kung higit sa isang vertebra ang nadurog, ang forward bending ay maaaring maipon, na nagbabago sa kung paano pumapasan ng load ang iyong buong spine at maaaring makadagdag sa ache at stiffness na iyong nararamdaman. Ang buto ay karaniwang gumagaling nang kusa sa loob ng ilang linggo hanggang buwan, ngunit dahil manipis ang buto, ang nagaling na vertebra ay maaaring patuloy na dahan-dahang mag-compress, at ang parehong kahinaan ay nangangahulugang posible ang isa pang fracture sa ibang bahagi.

Humigit-kumulang isa sa tatlong tao lamang na may mga spinal fracture na ito ang aktwal na nakararamdam ng sakit mula rito, kaya madali itong makaligtaan. Karamihan ay gumagaling sa paglipas ng panahon at sa pain medication lamang. Kung ang iyong sakit ay nananatiling severe sa kabila nito, may mga procedure na umiiral na maaaring magpatatag sa nadurog na buto at magpagaan ng sakit, na tatalakayin namin sa susunod.

Ano ang maaari naming gawin tungkol dito

Karamihan sa mga fracture na ito ay gumagaling nang walang operasyon. Ang unang hakbang ay ang pananatiling aktibo. Ang banayad na ehersisyo at paggalaw ay tumutulong sa paggaling ng buto, pinipigilan ang karagdagang pagkawala ng buto, at pinapanatili kang nakagagawa ng mga bagay na iyong kinagigiliwan. Ginagabayan ito ng physiotherapy: layunin nito na muling mabuo ang iyong lakas at kumpyansa habang humihilom ang fracture. Bigyan ito ng ilang linggo hanggang buwan, dahil ang buto ay karaniwang gumagaling nang kusa sa loob ng panahong iyon. Maaaring gumamit ng brace upang suportahan ang iyong likod habang ito ay gumagaling. Ang gamot sa sakit ay tumutulong sa iyo na manatiling gumagalaw sa panahon na ito.

Kasabay nito, inaalagaan namin ang mismong buto. Ang mga gamot sa osteoporosis ay maaaring magpatibay ng iyong buto at magpababa ng pagkakataon ng isa pang fracture. Ang kakulangan sa Vitamin D ay karaniwan sa mga fracture na ito, at sinusuri namin ito at itinatama bago ang anumang operasyon. Mahalaga ang gawaing ito para sa kalusugan ng buto: pinapabuti nito ang paggaling, binabawasan ang mga komplikasyon, at pinabababa ang panganib ng mga bagong fracture. Madalas itong nalalaktawan, ngunit ito ay isang mahalagang bahagi ng recovery pagkatapos ng anumang fracture na sanhi ng osteoporosis.

Kung ang iyong sakit ay malala pa rin pagkatapos ng pagsubok sa non-operative care, maaari naming talakayin ang isang procedure na tinatawag na vertebral augmentation. Ito ay isang minimally invasive na operasyon na nagpapatatag sa nadurog na vertebra gamit ang bone cement. Mayroong dalawang bersyon nito. Ang vertebroplasty ay itinuturok ang cement nang direkta. Ang kyphoplasty ay gumagamit muna ng isang maliit na balloon upang iangat ang collapsed na buto, pagkatapos ay pinupunan ang espasyo ng cement, na maaari ring magpahusay sa forward bend na sanhi ng fracture. Kyphoplasty ang opsyon na mas pinapaboran namin kapag ang non-operative care ay hindi nakatulong nang sapat. Ang mga procedure na ito ay ginagawa sa pamamagitan ng maliliit na butas sa halip na isang malaking incision, na nagpapanatili sa panganib na mababa para sa mga matatandang pasyente. Ang cement ay maaaring minsan na tumagas palabas ng buto habang isinasagawa ang procedure, at ito ay mas karaniwan sa vertebroplasty, kaya gumagamit kami ng mga teknik na iniangkop sa iyong fracture upang maiwasan ito. Ang operasyon ay may sariling pahina, na nagpapaliwanag kung ano ang mangyayari sa araw na iyon at kung ano ang kinapapalooban ng recovery.

Ano ang dapat asahan

Para sa karamihan ng mga tao, ang sakit mula sa isa sa mga fracture na ito ay humuhupa sa loob ng ilang linggo hanggang buwan habang kusa itong gumagaling. Karaniwang unang nababawasan ang matalas na sakit, at mas mabagal na nawawala ang mapurol na kirot. Ang pananatiling aktibo at pagpapanatili ng iyong lakas sa panahong ito ay nakatutulong, habang ang mahabang panahon ng pahinga ay maaaring maging kontra sa iyo sa pamamagitan ng pagpapahina pa lalo sa iyong mga buto at pagpapataas ng pagkakataon ng mga pagkadapa at mga bagong pinsala.

Kung maayos na napapamahalaan ang sakit, maaari mong asahan ang pagbabalik sa iyong mga normal na aktibidad habang humuhupa ang fracture. Kung ang iyong sakit ay malala at hindi nababawasan ng gamot sa sakit, ang isang procedure upang patatagin ang buto ay maaaring mag-alis ng sakit na iyon, at ang benepisyo nito kumpara sa gamot lamang ay maaaring tumagal sa unang taon. Layunin din ng mga procedure na ito na suportahan ang nadurog na vertebra upang ang spine ay hindi patuloy na yumuko pasulong sa antas na iyon.

May mga totoong limitasyon na dapat malaman. Dahil manipis ang iyong mga buto, posible ang isang bagong fracture sa isa pang vertebra pagkatapos nito, at mas mataas ang panganib kung ikaw ay mas matanda, kung nagkaroon ka na ng mga fracture sa buto noon, o kung mababa ang iyong bone density. Mas mababa ang panganib kapag ang osteoporosis mismo ay ginagamot ng mga gamot kasabay ng pag-aalaga sa fracture. Napapansin din ng ilang tao na ang collapsed vertebra ay dahan-dahang nawawalan ng higit pang taas sa paglipas ng panahon, na bahagi ng gawi ng manipis na buto sa halip na isang palatandaan na nabigo ang paggamot.

Kung ang isang fracture ay hinayaan lamang at ang pagyuko pasulong ay lumala, lalo na kung higit sa isa ang fracture, ang pagbabagong iyon sa hugis ay maaaring makaapekto sa kung paano dinadala ng iyong spine ang load at maaaring patuloy na magdulot ng mga problema. Ang pag-aalaga sa kalusugan ng iyong buto, pananatiling aktibo, at pagpapatuloy sa paggamot ng osteoporosis ay nagbibigay sa iyo ng pinakamahusay na pagkakataon na gumaling nang maayos at manatiling nakatayo.

Kailan dapat magpatingin

Magpatingin agad sa iyong GP kung ikaw ay higit sa 60 taong gulang at nakaranas ng biglaang sakit sa likod, kahit pagkatapos lamang ng maliit na pagkatisod o simpleng pagyuko. Ang mga fracture na ito ay madaling makaligtaan sa mga plain X-ray, kaya itanong kung kailangan ng karagdagang imaging. Pumunta sa emergency department kung makaranas ng bagong panghihina, pamamanhid o pangingilig sa iyong mga binti, o hirap sa pagkontrol ng iyong pantog o bituka. Humingi ng pagsusuri ng isang espesyalista kung nananatiling malala ang iyong sakit sa kabila ng mga gamot sa sakit pagkatapos ng ilang linggo, kung nagkaroon ka na ng isa sa mga fracture na ito at bumalik ang sakit o lumipat sa ibang level ng spine, o kung alam mong mayroon kang manipis na mga buto at may anumang bagong sakit sa likod.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Vertebral Column Anatomy

  • The vertebral column comprises 33 vertebrae divided into five sections: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal [16].
  • The sacral and coccygeal vertebrae are fused, typically allowing for 24 mobile segments [16].
  • A typical vertebra comprises an anterior body and a posterior arch that enclose the vertebral canal [16].
  • The neural arch is composed of two pedicles laterally and two laminae posteriorly that are united to form the spinous process [16].
  • To either side of the arch of the vertebral body is a transverse process and superior and inferior articular processes [16].
  • The articular processes articulate with adjacent vertebrae to form synovial joints [16].
  • The relative orientation of the articular processes accounts for the degree of flexion, extension, or rotation possible in each segment of the vertebral column [16].
  • The spinous and transverse processes serve as levers for the numerous muscles attached to them [16].
  • The length of the vertebral column averages 72 cm in men and 7 to 10 cm less in women [16].
  • The vertebral canal extends throughout the length of the column and provides protection for the spinal cord, conus medullaris, and cauda equina [16].

Intervertebral Disk Anatomy

  • The intervertebral disk connects adjacent vertebral bodies [6].
  • The adjacent vertebral bodies, the disk, and the facet joints constitute the functional spinal unit that provides mechanical stability and allows physiologic motion [6].
  • The intervertebral disks run between vertebral bodies from C2 to S1 and function to resist loads on the spine and provide stability [18].
  • The disks contribute up to one-third of the height of the spinal column [18].
  • The disk consists of the cartilaginous end plates of the vertebral bodies, the outer anulus fibrosus, and the inner nucleus pulposus [18].
  • The end plate serves as a point of attachment of the disk to the superior and inferior surfaces of the vertebral bodies [18].
  • The end plate is a thin layer of hyaline cartilage [18].
  • The nucleus pulposus is centrally located and confined by the end plates and the anulus fibrosus [6].
  • The nucleus pulposus resists compressive loads, dampens mechanical loads, and evenly distributes forces onto the end plates [6].
  • The nucleus pulposus is the remnant of the embryonic notochord and comprises the gelatinous center of the intervertebral disk [18].
  • The extracellular matrix of the nucleus pulposus is composed primarily of type II collagen and aggrecan, which makes it relatively hydrophilic [18].
  • The nucleus pulposus serves to resist axial loads as well as provide height to the intervertebral disk [18].
  • The anulus fibrosus is peripheral to the nucleus pulposus and confines the nucleus pulposus [6].
  • The anulus fibrosus is designed to resist tensile loads, allow spinal motion, provide mechanical connection between the vertebrae, and confine the nucleus pulposus [6].
  • The anulus fibrosus consists of concentrically layered fibrous cartilage lamellae primarily composed of type I collagen [18].
  • The fibers of the anulus fibrosus run in alternating oblique trajectories [18].
  • The anulus fibrosus resists tensile forces within the spine, including those due to the compression of the nucleus pulposus [18].
  • The end plates form the interface between the vertebrae and the disk and define the upper and lower boundaries of the disk [21].
  • The central portion of the end plate provides a major pathway for nutrients from the vertebral bodies to diffuse into the disk [21].

Disk Physiology and Pathophysiology

  • In a normal healthy lumbar disk, large aggregating proteoglycans (aggrecan and versican) constitute a high percentage of the dry weight in the nucleus [21].
  • Glycosaminoglycan molecules (keratan sulfate and chondroitin sulfate) decorate the aggrecan and versican core protein and are highly negatively charged [21].
  • The highly negatively charged glycosaminoglycans create a highly hydrophilic matrix that attracts H2O molecules [21].
  • The attraction of H2O molecules provides swelling pressure that counteracts the axial loads encountered by the disk [21].
  • The matrix is viscoelastic and therefore dissipates mechanical energy and is subject to creep [21].
  • Disk height is less at the end of each day due to creep [21].
  • The adult intervertebral disk is avascular and derives its nutrition through diffusion from terminal capillaries in the vertebral bodies just below the end plates [18].
  • In the adult, the blood supply ends at the bony end plate of the vertebral body and the outer anulus fibrosus [21].
  • Most of the disk is considered immunologically isolated due to its avascularity [21].
  • Nutrients are supplied to the disk cells primarily through diffusion [21].
  • As the disk gets larger during development, the distances that nutrition must diffuse across become larger, further impeding nutritional supply to the disk cells [21].
  • The decrease in nutritional transport is thought to contribute to disk degeneration [21].
  • Innervation of the intervertebral disk is confined to the peripheral anulus fibrosus [21].
  • The sinuvertebral nerve, which arises from the dorsal root ganglion, innervates the outer anulus fibrosus [21].
  • In some degenerated disks with fissures, nerve fibers may be found deeper in the anulus fibrosus [21].
  • The normal nucleus pulposus is not innervated [21].
  • Pain sensation from the disk arises only from the anulus fibrosus [21].
  • The nucleus pulposus can generate molecules such as cytokines and proteinases that can lead to pain [21].
  • With normal ageing, glycosaminoglycan production diminishes, leading to gradual desiccation of the disc [19].
  • The annulus fibrosus develops fissures and disc nuclear material may prolapse through during degeneration [19].
  • The discs lose height and bulge beyond the margins of the vertebral bodies during degeneration [19].
  • Disc protrusion against the ligaments causes formation of marginal osteophytes [19].
  • Adjacent vertebral end plates ossify and become sclerotic while fatty change occurs in the subchondral bone marrow during spondylosis [19].
  • Disc degeneration results in altered biomechanics and increased loading forces on the facet joints [19].
  • Facet joint osteoarthritis may lead to osteophyte encroachment into the canal causing spinal lateral recess stenosis [19].
  • The ligamentum flavum thickens, which contributes to stenosis, while the disc bulges from anteriorly into the spinal canal [19].

Osteoporosis Pathophysiology

  • Osteoporosis is the most common metabolic bone disease resulting from imbalance between bone formation and bone resorption [2].
  • Spinal fractures are the most common manifestation of osteoporosis [2].
  • Only one in three patients with spinal fractures are symptomatic [2].
  • In elderly patients, osteoporosis-related spinal fractures have similar morbidity and mortality as hip fractures [2].
  • Osteoporosis and low bone mass are present in about 50% of elective spine patients older than 50 years [2].
  • Osteoporosis and low bone mass negatively affect clinical outcomes and are associated with increased complications and revision surgery [2].
  • Vitamin D deficiency is present in the majority of spine patients [2].

Clinical Presentation

  • A history of fragility fracture significantly increases the risk of another fracture [15].
  • The relative risk of a subsequent fracture is two to three times higher in women with a prior fragility fracture [15].
  • The relative risk of a subsequent fracture is up to six times higher in men with a prior fragility fracture [15].
  • A history of greater than a single vertebral fracture significantly increases the risk of further vertebral fractures [15].
  • In a meta-analysis of nontreated patients enrolled in vertebroplasty studies, 18% had a secondary fracture within 12 months [15].

Investigations

Imaging Modalities

  • Dual energy x-ray absorptiometry (DXA) is the benchmark to assess bone mineral density (BMD) [25].
  • DXA measures areal BMD in g/cm² of the proximal femur, lumbar spine, and distal radius [25].
  • DXA is accurate and precise when calibrated and performed properly [25].
  • DXA involves a very low radiation dose [25].
  • BMD is reported as a standard deviation difference to a reference standard [25].
  • T-score is the reference standard for young healthy females [25].
  • Z-score is the reference standard for age- and gender-matched subjects [25].
  • Vertebral fracture assessment (VFA) can be performed at the time of DXA [25].
  • VFA identifies occult vertebral fracture in 20% to 30% of cases [25].
  • VFA is useful to change a diagnosis from low bone mass (osteopenia) to osteoporosis [25].
  • Opportunistic CT uses CT data to estimate bone status [25].
  • CT is based on the attenuation coefficient called the Hounsfield unit (HU) [25].
  • Hounsfield units are related to BMD and can be used to estimate BMD and the presence of osteoporosis [25].
  • PACS tools can calculate mean HU for any elliptical region of interest [25].
  • Most osteoporotic vertebral fractures can be diagnosed by plain radiographs or CT [26].
  • MRI can show edema in the vertebral body to indicate a recent fracture when age determination is required [26].
  • An acute measured height change of greater than 1 inch is suggestive of an acute vertebral fracture [26].

Laboratory and Preoperative Assessment

  • Greater than 75% of patients older than 50 years having elective spine surgery have vitamin D insufficiency or deficiency [14].
  • Vitamin D deficiency is linked to increased pain severity in spinal stenosis [14].
  • Ravindra demonstrated slower fusion and lower rates of success in vitamin D–deficient patients [14].
  • Kim found that baseline low vitamin D was associated with worse Oswestry Disability scores at follow-up [14].
  • Vitamin D deficiency is treatable but takes 6 weeks [14].
  • Osteoporosis is linked to subsidence of cages, pedicle screw loosening, proximal junction failure, poorer fusion rates, increased spondylolisthesis after laminectomy, and higher rates of revision surgery [14].
  • Bjerke reviewed 140 lumbar fusion patients and found that 10 were osteoporotic and 59% had low bone mass [14].
  • Nonunion was 50% in osteoporotic patients compared with 18% in those with low bone mass or normal BMD [14].
  • Osteoporosis-related complications occurred in 23% of patients with normal BMD, 28% of patients with low bone mass, and 46% of osteoporotic patients [14].
  • Complication rates worsened relative to BMD when more than single-level fusion was performed [14].
  • The AOA suggests using the same principles as outlined for secondary fracture prevention for preoperative bone health optimization [14].
  • Inclusion criteria for preoperative bone health optimization assessment include all patients having thoracolumbar surgery who are older than 50 years [14].
  • Preoperative patients are recommended to consume vitamin D3 2,000 U daily and 1,200 mg calcium in the diet [14].
  • Preoperative patients should be assessed for fall risk and considered for physical therapy if warranted [14].
  • Patients who do not need DXA or who screen negative for DXA should undergo surgery [14].
  • Patients with low bone mass or osteoporosis should be considered for preoperative bone health optimization [14].
  • If medically indicated, patients are treated with diphosphonate or anabolic medication before surgery [14].
  • The duration of preoperative treatment is unknown, but effects of bone strength and physiology are seen within 2 months [14].
  • A minimum of 3 months of preoperative treatment is recommended if clinically possible before surgery [14].
  • Longer treatment up to 9 months should be considered for multilevel or high-risk cases such as osteotomy [14].
  • Antiosteoporosis medications should be continued postoperatively [14].
  • Multiple RCTs comparing biphosphonates and placebo in patients undergoing lumbar spine fusion show improved clinical outcomes, radiologic outcomes, and lower risk of complications [14].
  • Biphosphonates do not appear to be associated with any impairment of bone health [14].
  • One RCT and multiple cohort studies show that teriparatide can lead to improved clinical outcomes, radiologic outcomes, and lower risk of complications in spinal fusion patients [14].

Treatment

Non-Operative Management

  • The initial treatment of osteoporotic vertebral fractures is nonsurgical [2].
  • Secondary fracture prevention is performed in less than 20% of cases following osteoporosis-related fractures [2].
  • Secondary fracture prevention includes education, assessment of bone health, nutritional supplements, weight-bearing exercise, fall prevention, and pharmaceutical medications if indicated [2].
  • A history of fragility fracture increases the relative risk of another fracture by two to three times in women and up to six times in men [15].
  • Secondary treatment was given in 10% of patients in a Medicare database analysis but was associated with a reduced risk of fracture by 40% [15].
  • The American Orthopaedic Association (AOA) Own the Bone program is located in all states and 150 sites in the United States [15].
  • The AOA Own the Bone program significantly improves compliance with treatment recommendations after fragility fracture [15].
  • A prospective randomized controlled non-inferiority trial found that rigid brace, soft brace, and no brace treatments for osteoporotic compression fractures without neurologic injury had comparable outcomes [1].
  • Vitamin D deficiency is present in the majority of spine patients and should be corrected after fracture and before elective surgery [2].
  • Routine use of vitamin D (1,000 to 2,000 IU/day) and calcium supplementation for all spine fusion patients aged 65 years or older may help avoid nonunion and infection [28].
  • Target serum 25-hydroxyvitamin D levels are 30 ng/mL [28].

Operative Management: Cement Augmentation

  • Vertebroplasty or kyphoplasty is considered for osteoporotic vertebral fracture in patients who are hospitalized for pain, those who do not improve with nonoperative care, or those who have progressive collapse [2].
  • A 2009 multicenter trial by Kallmes et al. found that vertebroplasty and a simulated procedure without cement resulted in similar improvements in pain [29].
  • A 2009 multicenter, randomized, double-blinded placebo-controlled trial by Buchbinder et al. identified no clinical benefit to vertebroplasty compared to a simulated procedure at follow-up visits ranging from 1 week to 6 months [29].
  • A multicenter European randomized control trial by Klazen et al. concluded that vertebroplasty was safe and provided immediate and sustained pain relief and improvement in quality of life to a significantly greater degree than nonsurgical treatment [29].
  • A randomized control study by Boonen et al. showed that kyphoplasty and vertebroplasty significantly reduced pain, improved early mobility, and enhanced short-term quality of life compared to noninvasive management options [29].
  • A systematic review by Taylor et al. showed that kyphoplasty and vertebroplasty significantly reduced pain, improved early mobility, and enhanced short-term quality of life compared to noninvasive management options [29].
  • Balloon kyphoplasty may correct the loss of vertebral body height, a predictor of progressive kyphosis, but this has only been confirmed on a limited basis for kyphoplasty and not for vertebroplasty [29].
  • Vertebroplasty and kyphoplasty are largely equivalent in their ability to provide pain relief and functional improvement, with little advantage gained by performing kyphoplasty given its significantly greater cost [29].
  • A Medicare database analysis by Edidin et al. identified lower mortality (39% vs. 50%) in patients treated with vertebroplasty compared to patients treated noninvasively [29].
  • A 2018 Cochrane Review by Buchbinder et al. analyzing 21 randomized and quasi-randomized controlled trials concluded that current high- to moderate-quality evidence does not support a role for vertebroplasty in the routine treatment of acute or subacute osteoporotic vertebral fractures [29].
  • The 2018 Cochrane Review by Buchbinder et al. could not identify sufficient evidence to support any clinically relevant benefit to vertebroplasty compared to placebo [29].
  • Subgroup analyses in the 2018 Cochrane Review showed that results were not affected by whether the duration of pain was less than or greater than 6 weeks [29].
  • Adverse events identified in the 2018 Cochrane Review included thromboembolic events, cement leakage, spinal cord compression, neurologic injury, respiratory failure, and osteomyelitis [29].
  • A randomized study by Firanescu et al. comparing vertebroplasty with a placebo (simulated procedure) control group found a similar, statistically significant reduction in pain as measured by visual analog scale (VAS) scores for both groups during 12-month follow-up [29].

Preoperative Bone Health Optimization

  • Greater than 50% of patients older than 50 years having elective spine surgery have low bone mass or osteoporosis [14].
  • Vitamin D deficiency is treatable but will take 6 weeks [14].
  • In a review of 140 lumbar fusion patients by Bjerke, nonunion was 50% in osteoporotic patients compared with 18% in those with low bone mass or normal BMD [14].
  • In a review of 140 lumbar fusion patients by Bjerke, osteoporosis-related complications occurred in 23% of patients with normal BMD, 28% in patients with low bone mass, and 46% in osteoporotic patients [14].
  • Inclusion criteria for preoperative bone health optimization include all patients having thoracolumbar surgery who are older than 50 years of age [14].
  • Preoperative patients are recommended to consume vitamin D3 2,000 U daily and 1,200 mg calcium in diet [14].
  • Preoperative patients should be assessed for fall risk and consider physical therapy if warranted [14].
  • Patients who have low bone mass or osteoporosis should be considered for preoperative bone health optimization [14].
  • The author recommends a minimum of 3 months of preoperative treatment if clinically possible, as effects of bone strength and physiology are seen within 2 months [14].
  • For multilevel or high-risk cases such as osteotomy, longer treatment up to 9 months should be considered [14].

Complications

  • Osteoporosis and vitamin D deficiency are associated with poorer outcomes, recurrent fractures, and higher complication risks [2].
  • Osteoporosis and low bone mass negatively affect clinical outcomes and are associated with increased complications and revision surgery in elective spine patients older than 50 years [2].
  • Preoperative and postoperative treatment of osteoporosis in spine surgery patients has been shown to improve outcomes and reduce complications [2].

References

[1] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > XV. Conclusion > Bibliography.

[2] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > XV. Conclusion.

[6] Aaos Comprehensive Orthopaedic Review 3. Intervertebral Disk > I. Function.

[14] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > XIV. Preoperative Bone Health Optimization.

[15] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > XII. Secondary Fracture Prevention.

[16] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTION OF THE PATELLOFEMORAL AND PATELLOTIBIAL LIGAMENTS WITH A SEMITENDINOSUS TENDON GRAFT > ANATOMY OF VERTEBRAL COLUMN.

[18] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Spinal Anatomy > Intervertebral Disk.

[19] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INTERVERTEBRAL DISC LESIONS.

[21] Aaos Comprehensive Orthopaedic Review 3. Intervertebral Disk > II. Anatomy.

[25] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > V. Diagnosis of Osteoporosis.

[26] Aaos Comprehensive Orthopaedic Review 3. Assessment and Treatment of Osteoporosis and Vertebral Fractures* > XIII. Osteoporotic Vertebral Fractures.

[28] Rockwood And Green S Fractures In Adults. Imaging of Cervical Spine Fractures and Dislocations > Special Considerations in Thoracolumbar Spine Fractures and Dislocations > Treatment Options for Osteoporotic Vertebral Fractures.

[29] Rockwood And Green S Fractures In Adults. Imaging of Cervical Spine Fractures and Dislocations > Operative Treatment of Osteoporotic Vertebral Fractures > Cement Augmentation.

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