Immobility predisposes patients to venous thrombosis and life-threatening complications such as pulmonary embolism [101]. It can also lead to pressure ulcers, pulmonary complications, urinary tract infections, and progressive deconditioning. Medical management is often complementary to other treatment strategies. To reduce pain and thus promote early mobilization with conservative management, appropriate analgesics should be prescribed. Narcotics should be reserved for patients who receive inadequate relief from regular analgesics and have to be used with caution given the associated effects of sedation, nausea, further decrease in physical conditioning, and fall risks. Most patients with osteoporotic VCF have spontaneous resolution of pain, even without medication, in 6 to 8 weeks [103,104,108,113]. Prevention and treatment of osteoporosis are one of the first steps in managing VCFs. Cigarette smoking should be discouraged, and alcohol should only be consumed in moderation. A daily weight-bearing exercise program should be recommended [101]. Patients may not be candidates for percutaneous or surgical intervention because of factors related to performance status, pregnancy, infection, or coagulation disorders, among others. Clinical decision-making must account for the overall risk and benefit to the patient. Vertebral Compression Fractures Percutaneous Vertebral Augmentation VA, in the form of VP and BK, may be offered to patients who have failed conservative therapy for 3 months [34]. However, recent studies have found VA superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks duration [22]. Two randomized controlled trials that reported no statistically significant advantage for VA versus sham therapy raised discussions and controversial editorials, particularly regarding the inclusion criteria and other methodological issues [113,114].
Management of Vertebral Compression Fractures PCAs. Immobility predisposes patients to venous thrombosis and life-threatening complications such as pulmonary embolism [101]. It can also lead to pressure ulcers, pulmonary complications, urinary tract infections, and progressive deconditioning. Medical management is often complementary to other treatment strategies. To reduce pain and thus promote early mobilization with conservative management, appropriate analgesics should be prescribed. Narcotics should be reserved for patients who receive inadequate relief from regular analgesics and have to be used with caution given the associated effects of sedation, nausea, further decrease in physical conditioning, and fall risks. Most patients with osteoporotic VCF have spontaneous resolution of pain, even without medication, in 6 to 8 weeks [103,104,108,113]. Prevention and treatment of osteoporosis are one of the first steps in managing VCFs. Cigarette smoking should be discouraged, and alcohol should only be consumed in moderation. A daily weight-bearing exercise program should be recommended [101]. Patients may not be candidates for percutaneous or surgical intervention because of factors related to performance status, pregnancy, infection, or coagulation disorders, among others. Clinical decision-making must account for the overall risk and benefit to the patient. Vertebral Compression Fractures Percutaneous Vertebral Augmentation VA, in the form of VP and BK, may be offered to patients who have failed conservative therapy for 3 months [34]. However, recent studies have found VA superior to placebo intervention for pain reduction in patients with acute osteoporotic VCF of <6 weeks duration [22]. Two randomized controlled trials that reported no statistically significant advantage for VA versus sham therapy raised discussions and controversial editorials, particularly regarding the inclusion criteria and other methodological issues [113,114].