AAOS Guideline on The Treatment of Osteoporotic Spinal Compression Fractures
Summary of Recommendations
The following is a summary of the recommendations in the AAOS’ clinical practice guideline, The Treatment of Symptomatic Osteoporotic Spinal Compression fractures. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility.
This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, and other healthcare practitioners.
We suggest patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms suggesting an acute injury (0 to five days after identifiable event or onset of symptoms) and who are neurologically intact be treated with calcitonin for four weeks.
Strength of Recommendation: Moderate
Ibandronate and strontium ranelate are options to prevent additional symptomatic fractures in patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms.
Strength of Recommendation: Weak
We are unable to recommend for or against bed rest, complementary and alternative medicine, or opioids/analgesics for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
It is an option to treat patients who present with an osteoporotic spinal compression fracture at L3 or L4 on imaging with correlating clinical signs and symptoms suggesting an acute injury and who are neurologically intact with an L2 nerve root block.
Strength of Recommendation: Weak
We are unable to recommend for or against treatment with a brace for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against a supervised or unsupervised exercise program for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against electrical stimulation for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We recommend against vertebroplasty for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Strong
Kyphoplasty is an option for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Weak
We are unable to recommend for or against improvement of kyphosis angle in the treatment of patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against any specific treatment for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are not neurologically intact.
Strength of Recommendation: Inconclusive
