• Treatment of Symptomatic Osteoporotic Spinal Compression Fractures

    Reviewed but not Endorsed
    Sponsor: American Academy of Orthopaedic Surgeons
    Specialty: Spine
    Publisher: AAOS, 2010

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    OVERVIEW

    This clinical practice guideline is based on a systematic review of published studies on the treatment of symptomatic osteoporotic spinal compression fractures in adults. In addition to providing practice recommendations, this guideline also highlights gaps in the literature and areas that require future research.

    This guideline is intended to be used by all appropriately trained surgeons and all qualified physicians managing the treatment of symptomatic osteoporotic spinal compression fractures. It is also intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations.

    GOALS AND RATIONALE

    The purpose of this clinical practice guideline is to help improve treatment based on the current best evidence. Current evidence-based medicine (EBM) standards demand that physicians use the best available evidence in their clinical decision making. To assist in this, this clinical practice guideline consists of a systematic review of the available literature regarding the treatment of symptomatic osteoporotic spinal compression fractures. The systematic review detailed herein was conducted between March 2009 and February 2010 and demonstrates where there is good evidence, where evidence is lacking, and what topics future research must target in order to improve the treatment of patients with symptomatic osteoporotic spinal compression fractures. AAOS staff and the physician work group systematically reviewed the available literature and subsequently wrote the following recommendations based on a rigorous, standardized process. Musculoskeletal care is provided in many different settings by many different providers. We created this guideline as an educational tool to guide qualified physicians through a series of treatment decisions in an effort to improve the quality and efficiency of care. This guideline should not be construed as including all proper methods of care or excluding methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment must be made in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

    INTENDED USERS

    This guideline is intended to be used by orthopaedic surgeons and all qualified physicians managing patients with symptomatic osteoporotic spinal compression fractures. Typically, orthopaedic surgeons will have completed medical training, a qualified residency in orthopaedic surgery, and some may have completed additional sub-specialty training. Insurance payers, governmental bodies, and health-policy decision-makers may also find this guideline useful as an evolving standard of evidence regarding treatment of symptomatic osteoporotic spinal compression fractures.

    Treatment for symptomatic osteoporotic spinal compression fractures is based on the assumption that decisions are predicated on patient and physician mutual communication with discussion of available treatments and procedures applicable to the individual patient. Once the patient has been informed of available therapies and has discussed these options with his/her physician, an informed decision can be made. Clinician input based on experience with conservative management and the clinician’s surgical experience and skills increases the probability of identifying patients who will benefit from specific treatment options.

    PATIENT POPULATION

    This document addresses the treatment of symptomatic osteoporotic spinal compression fractures in adults (defined as patients 18 years of age and older).

    ETIOLOGY

    Symptomatic osteoporotic spinal compression fractures are a result of osteoporosis.

    INCIDENCE

    Symptomatic osteoporotic spinal compression fractures are a common occurrence. About 750,000 new vertebral fractures occur each year in the United States.1

    BURDEN OF DISEASE

    The economic burden of treating incident osteoporotic fractures was estimated at $17 billion in 2005.

    EMOTIONAL AND PHYSICAL IMPACT

    Symptomatic osteoporotic spinal compression fractures cause pain, loss of physical function, and are associated with increased mortality.

    POTENTIAL BENEFITS, HARMS, AND CONTRAINDICATIONS

    The aim of treatment is pain relief and recovery of mobility. Most treatments are associated with some known risks, especially invasive and operative treatments. In addition, contraindications vary widely based on the treatment administered. Therefore, discussion of available treatments and procedures applicable to the individual patient rely on mutual communication between the patient and physician, weighing the potential risks and benefits for that patient.

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