Conservative Treatment of Acute Vertebral Fractures Save

A network meta-analysis of pain outcomes in patients with acute osteoporotic vertebral compression fractures (VCFs) showed short-term success with calcitonin and NSAIDs in decreasing pain during activity, but long-term benefits were superior for teriparatide compared to bisphosphonates.

This study was designed to assess and compare conservative treatment outcomes in managing acute pain related to VCF.  A systematic review and network meta-analysis included 20 trials (2102 patients) and looked at conservative interventions, including bisphosphonates, calcitonin, teriparatide, nonsteroidal anti-inflammatory drugs (NSAIDs), and braces. Primary outcomes were short-term (4 weeks) pain during activity and long-term (latest available follow-up) nonspecified pain in patients with acute VCF.

Results showed that Calcitonin (−4.86; 95% CI, −6.87 to −2.86)  and NSAIDs (−3.94; −7.30 to −0.58) were superior to placebo regarding short-term pain during activity. 

Long-term nonspecific pain management, no treatment was significantly better than NSAIDs, but teriparatide was superior to bisphosphonates.  

There was limited benefit with braces and analgesics.There was no significant difference in adverse events. 

NSAIDs and teriparatide may be the preferred treatment options for pain management in acute osteoporotic VCF. Calcitonin may to be beneficial, but its safety profile and potential adverse effects restrict its widespread application.