The Treatment of Symptomatic Osteoporotic Spinal Compression Fractures

J Am Acad Orthop Surg, Vol 19, No 3, March 2011

Stephen I. Esses, MD, Robert McGuire, MD, John Jenkins, MD, Joel Finkelstein, MD, Eric Woodard, MD, William C. Watters, III, MD, Michael J. Goldberg, MD, Michael Keith, MD, Charles M. Turkelson, PhD, Janet L. Wies, MPH, Patrick Sluka, MPH, Kevin M. Boyer and Kristin Hitchcock, MLS The complete guideline, which includes all tables, figures, and appendices, is available at http://www.aaos.org/research/guidelines/SCFguideline.pdf This clinical practice guideline is based on a series of systematic reviews of published studies on the treatment of symptomatic osteoporotic spinal compression fractures. Of 11 recommendations, one is strong; one, moderate; three, weak; and six, inconclusive. The strong recommendation is against the use of vertebroplasty to treat the fractures; the moderate recommendation is for the use of calcitonin for 4 weeks following the onset of fracture. The weak recommendations address the use of ibandronate and strontium ranelate to prevent additional symptomatic fractures, the use of L2 nerve root blocks to treat the pain associated with L3 or L4 fractures, and the use of kyphoplasty to treat symptomatic fractures in patients who are neurologically intact.