The current lack of suitable biomarkers for osteoporotic vertebral compression fractures has led to a shortage of significant evidence in the field and has left physicians no choice but to rely on their own clinical expertise when helping patients. The primary purpose of this review is to provide a comprehensive up-to-date overview of the most commonly used treatment strategies for compression fractures, including newly developed vertebral augmentation procedures. This problem influences the ability of researchers to make reliable conclusions when evaluating the currently available treatment options. 8, 9 One significant reason for the current lack of quality evidence, which the AAOS encountered while developing the current guidelines, is the absence of a dependable biomarker that can predict the development of future compression fractures. ![]() ![]() 7 Other studies have questioned their effectiveness and have proposed that the use of vertebral augmentation may not be beneficial at all when compared with conservative pain management. 3, 4 Unfortunately, there are no clear guidelines defining at what point vertebral augmentation should be performed, and in fact, some authors have suggested utilizing these approaches prophylactically, even in nonfractured vertebral bodies. 3, 6 Percutaneous vertebroplasty and balloon-assisted kyphoplasty are the two commonly used minimally invasive vertebral augmentation procedures to restore normal vertebral height, reduce pain, and minimize deformity. In clinical practice, once a diagnosis is confirmed, the first line of treatment is usually conservative pain management with or without some degree of back support and physiotherapy. ![]() The strength of the AAOS guidelines depends on the amount and quality of data currently present: strong and moderate recommendations should generally be followed by clinicians, whereas limited and inconclusive recommendations have insufficient evidence backing them and therefore result in little help for practicing physicians, who are left relying on personal judgment. 4 The only published clinical practice guidelines have been developed by the American Academy of Orthopedic Surgeons (AAOS), and of the 11 recommendations, only 1 has strong and 1 has moderate evidence backing them 9 recommendations are weak or inconclusive. The American College of Radiology has published some appropriateness criteria for the different management options, yet there is still a lack of consensus when it comes to developing a standard of care. In fact, the medical community is undecided as to what the optimal mode of treatment really is. However, algorithms for determining the best treatment option have not been developed to help guide physicians treating new patients. ![]() 3Ĭurrently, many treatment options are available for the management of osteoporotic vertebral compression fractures. 2 Patients typically present with back pain and get diagnosed with a vertebral fracture following X-ray imaging. 1 Vertebral compression fractures have a greater than 15% reduction in vertebral body height and are most often observed in the thoracolumbar transition zone. Among them are 700,000 vertebral fractures. In the United States, there are ∼1.5 million fractures attributed to osteoporosis every year.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |