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Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

Asian Spine Journal 2020년 14권 6호 p.898 ~ 909
장해동, 김응하, 이재철, 최성우, 김경범, 신병준,
소속 상세정보
장해동 ( Jang Hae-Dong ) - Soonchunhyang University Bucheon Hospital Department of Orthopedic Surgery
김응하 ( Kim Eung-Ha ) - Soonchunhyang University Bucheon Hospital Department of Orthopedic Surgery
이재철 ( Lee Jae-Chul ) - Soonchunhyang University Seoul Hospital Department of Orthopedic Surgery
최성우 ( Choi Sung-Woo ) - Soonchunhyang University Seoul Hospital Department of Orthopedic Surgery
김경범 ( Kim Kyung-Bum ) - Soonchunhyang University Bucheon Hospital Department of Orthopedic Surgery
신병준 ( Shin Byung-Joon ) - Soonchunhyang University Seoul Hospital Department of Orthopedic Surgery

Abstract


Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%?35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.

키워드

Spine; Osteoporosis; Vertebral augmentation; Neurology; Teriparatide

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