Vertebral fractures associated with osteoporosis: patient management

With the growing interest in new treatments aimed at preventing bone loss and conserving bone mass, insufficient attention has been given to symptomatic treatment of patients with vertebral fractures. Patients often believe that the pain and impaired mobility associated with these fractures are permanent and that little can be done to help. This is a serious misconception. Prompt intervention using a multidisciplinary approach can hasten recovery from pain; improve mobility, flexibility, and speed of movement; and restore independence. Individualized care is needed because clinical features and degree of physical disability vary widely. Asymptomatic patients with vertebral fractures require evaluation and a management plan aimed at maintaining bone mass, improving functional status of the affected region, and preventing pain and new fractures. For patients with acute or chronic pain, treatment of pain and functional limitations is the first priority, followed by functional rehabilitation and preservation of bone mass. A multidisciplinary approach to long-term care is recommended and includes lifestyle re-education, physical therapy, physical fitness training, neurologic and orthopedic evaluation, and, for some patients, use of an orthosis. After 4-6 weeks, those patients for whom pain is persistent require detailed study to detect neurologic, myofascial, or orthopedic complications that can lead to chronic impairment of mobility. Vertebroplasty, surgery using different modalities, new exercise programs, and lifestyle modifications, together with more potent and effective medications to improve bone quality, are options to be used in the individual patient. Well-designed studies are needed that specifically examine the management of these patients, particularly in the areas of pain relief and functional rehabilitation.