The question how to treat acute painful vertebral fractures was recently addressed by the ECTS Clinical Action Group. The group conducted a systematic review and network meta-analysis and provided a comprehensive evaluation of conservative treatments, for pain relief in osteoporotic vertebral compression fractures (VCFs). The findings were recently published in JAMA Network Open.
The review included 20 trials involving 2,102 patients, focusing on treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), calcitonin, bisphosphonates and teriparatide. Short-term pain relief during activities like walking was found to be most effective with calcitonin and NSAIDs, while bisphosphonates were less effective. For long-term pain management, teriparatide was found to be superior to bisphosphonates.
Interestingly, while calcitonin was found to be effective in reducing short-term pain, concerns over its adverse effects (GI side effects and possible cancer risk) limit its widespread use. On the other hand, NSAIDs were highlighted for their ability to manage acute pain, despite limited research on their long-term impact. Braces, which are often prescribed for VCF, did not show significant long-term benefits in pain management.
In summary this study found NSAIDs and teriparatide to be most effective in treating acute VCFs and highlights the pressing need for further research on conservative management options, particularly regarding treatment safety and efficacy in the long term. With surgical options like vertebroplasty and kyphoplasty showing inconsistent results, conservative therapies remain a critical area for clinical investigation.
The research was a collaborative effort of the ECTS Clinical Action Group and the paper will be presented and discussed at an upcoming ECTS webinar.