[Orthopaedic management for severe osteoporosis]

In severe-osteoporotic patients with vertebral fractures, back pain is usually a major complaint and can be acute or chronic. Acute back pain is usually due to a recent vertebral fracture. Chronic pain may be due to vertebral fractures per se or could result from kyphotic or scoliotic changes in the spine, with inappropriate stretching of ligaments, facet joint capsules and paraspinal muscles. Treatment of vertebral fractures must focus on relief of pain and prevention of further fractures. In many patients, significant symptomatic relief can be achieved through physical therapy, rehabilitation, and bracing. Muscle-strengthening and weight-loading exercises could be needed for prevention of further bone loss and fractures.