Abstract
Purpose
The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries.
Methods
We conducted a systematic review and best evidence synthesis of systematic reviews on the non-invasive management of OVCF. Eligible reviews were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Low risk of bias systematic reviews and high-quality primary studies that were identified in the reviews were used to develop recommendations.
Results
From 6 low risk of bias systematic reviews and 14 high-quality primary studies we established that for acute pain management, in addition to rest and analgesic medication, orthoses may provide temporary pain relief, in addition to early mobilization. Calcitonin can be considered as a supplement to analgesics; however, cost is of concern. Once acute pain control is achieved, exercise can be effective for improving function and quality of life.
Conclusion
The findings from this study will help to inform the GSCI care pathway and model of care for use in medically underserved areas and low- and middle-income countries. Conservative management of acute pain and recovery of function in adults with OVCF should include early mobilization, exercise, spinal orthosis for pain relief, and calcitonin for analgesic-refractory acute pain.
Graphical Abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
American Association of Neurological Surgeons (2016) Vertebral compression fractures. http://www.aans.org/patient%20information/conditions%20and%20treatments/vertebral%20compression%20fractures.aspx. Accessed 1 Dec 2016
Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res (189):65–76
Cooper C, Melton LJ III (1992) Epidemiology of osteoporosis. Trends Endocrinol Metab 3:224–229. https://doi.org/10.1016/1043-2760(92)90032-V
Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 21:492–499
Handa R, Ali Kalla A, Maalouf G (2008) Osteoporosis in developing countries. Best Pract Res Clin Rheumatol 22:693–708. https://doi.org/10.1016/j.berh.2008.04.002
World Health Organization (2007) WHO scientific group on the assessment of osteoporosis at primary health care level. http://www.who.int/chp/topics/Osteoporosis.pdf. Accessed 27 Jan 2017
Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733. https://doi.org/10.1007/s00198-006-0172-4
Felsenberg D, Silman AJ, Lunt M, Armbrecht G, Ismail AA, Finn JD, Cockerill WC, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Dequeker J, Eastell R, Felsch B, Gowin W, Havelka S, Hoszowski K, Jajic I, Janott J, Johnell O, Kanis JA, Kragl G, Lopes Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Parisi G, Pols HA, Poor G, Raspe HH, Reid DM, Reisinger W, Schedit-Nave C, Stepan JJ, Todd CJ, Weber K, Woolf AD, Yershova OB, Reeve J, O’Neill TW (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724. https://doi.org/10.1359/jbmr.2002.17.4.716
Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137. https://doi.org/10.1007/s11657-013-0137-0
Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Al-Sari UA, Tobias J, Clark E (2016) Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 27:2891–2900. https://doi.org/10.1007/s00198-016-3648-x
Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):S27–S31
Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157. https://doi.org/10.1359/jbmr.1997.12.1.152
Blau LA, Hoehns JD, Nazario M, Gagnon L (2003) Analgesic efficacy of calcitonin for vertebral fracture pain. Ann Pharmacother 37:564–570. https://doi.org/10.1345/aph.1C350
Knopp-Sihota JA, Newburn-Cook CV, Homik J, Cummings GG, Voaklander D (2012) Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int 23:17–38. https://doi.org/10.1007/s00198-011-1676-0
Knopp JA, Diner BM, Blitz M, Lyritis GP, Rowe BH (2005) Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int 16:1281–1290
Longo UG, Loppini M, Denaro L, Maffulli N, Denaro V (2012) Conservative management of patients with an osteoporotic vertebral fracture: a review of the literature. J Bone Jt Surg Br 94:152–157. https://doi.org/10.1302/0301-620X.94B2.26894
Dusdal K, Grundmanis J, Luttin K, Ritchie P, Rompre C, Sidhu R, Harris SR (2011) Effects of therapeutic exercise for persons with osteoporotic vertebral fractures: a systematic review. Osteoporos Int 22:755–769. https://doi.org/10.1007/s00198-010-1497-6
Giangregorio LMM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A (2013) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev 1:CD008618. https://doi.org/10.1002/14651858.CD008618.pub2
Giele BM, Wiertsema SH, Beelen A, van der Schaaf M, Lucas C, Been HD, Bramer JA (2009) No evidence for the effectiveness of bracing in patients with thoracolumbar fractures. Acta Orthop 80:226–232. https://doi.org/10.3109/17453670902875245
Chen LX, Li YL, Ning GZ, Li Y, Wu QL, Guo JX, Shi HY, Wang XB, Zhou Y, Feng SQ (2015) Comparative efficacy and tolerability of three treatments in old people with osteoporotic vertebral compression fracture: a network meta-analysis and systematic review. PLoS One 10:e0123153. https://doi.org/10.1371/journal.pone.0123153
Rzewuska M, Ferreira M, McLachlan AJ, Machado GC, Maher CG (2015) The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. Eur Spine J 24:702–714. https://doi.org/10.1007/s00586-015-3821-5
Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C (2009) An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol 62(9):944–952
McGowan JSM, Lefebvre C (2010) An evidence based checklist for the peer review of electronic search strategies. Evid Based Libr Inf Pract 5(1):149–154
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10. https://doi.org/10.1186/1471-2288-7-10
Slavin RE (1995) Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 48:9–18
Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed) 339:b2535. https://doi.org/10.1136/bmj.b2535
Chou R, Hashimoto R, Friedly J, Fu R, Dana T, Sullivan S, Bougatsos C, Jarvik J (2015) AHRQ Technology assessments. In: Pain management injection therapies for low back Pain. Agency for Healthcare Research and Quality (US), Rockville (MD)
National Institute for Health and Care Excellence (NICE) (2012) The guidelines manual. https://www.nice.org.uk/article/pmg6/chapter/1%20introduction#ftn.footnote_1. Accessed 16 May 2016
de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC (2009) Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 20:2111–2125. https://doi.org/10.1007/s00198-009-0938-6
Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778. https://doi.org/10.1007/s00198-004-1675-5
Bajaj S, Saag KG (2003) Osteoporosis: evaluation and treatment. Curr Womens Health Rep 3:418–424
Anonymous (2000) Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement 17:1–45
Hough SM, Mahlati MP (2000) Diagnosis and management of osteoporosis-full guideline. S Afr Med J 90:907–944
Coggins ME (1995) Nonunions and malunions of thoracolumbar spine injuries. Semin Spine Surg 7:137–140
Consoli V, Alfieri P, Giuntini C, Mancia M, Avaldi F, Soncini R (1991) A double blind placebo-controlled trial of the efficacy and tolerability of intranasal elcatonin administered to patients suffering from senile and postmenopausal osteoporosis. Curr Ther Res 50:369–378
Vorsanger GJ, Farrell J, Xiang J, Chow W, Moskovitz BL, Rosenthal NR (2013) Tapentadol, oxycodone or placebo for acute pain of vertebral compression fractures: a randomized Phase IIIb study. Pain Manag 3:109–118. https://doi.org/10.2217/pmt.13.5
Zhang THD, YH, Yu SM, Zhnag C, Ya B (2013) Analgesics osteoporotic fracture healing. J Clin Rehabil Tissue Eng Res 17:6364-6374
World Health Organization WHO’s cancer pain ladder for adults. http://www.who.int/cancer/palliative/painladder/en/. Accessed 5 Feb 2017
Lyritis GP, Ioannidis GV, Karachalios T, Roidis N, Kataxaki E, Papaioannou N, Kaloudis J, Galanos A (1991) Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study. Calcif Tissue Int 49:369–372
Lyritis GP, Paspati I, Karachalios T, Ioakimidis D, Skarantavos G, Lyritis PG (1997) Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures. A double blind, placebo-controlled clinical study. Acta Orthop Scand Suppl 275:112–114
Lyritis GP, Ioannidis GV, Karachalios T, Roidis N, Kataxaki E, Papaioannou N, Kaloudis J, Galanos A (1999) Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, randomized, placebo-controlled clinical study. Clin J Pain 15:284–289
Pontiroli AE, Pajetta E, Scaglia L, Rubinacci A, Resmini G, Arrigoni M, Pozza G (1994) Analgesic effect of intranasal and intramuscular salmon calcitonin in post-menopausal osteoporosis: a double-blind, double-placebo study. Aging (Milan, Italy) 6:459–463
Flynn JA, Choi MJ, Wooster LD (2013) Oxford American handbook of clinical medicine. Oxford University Press, New York
Carroll R, Matfin G (2010) Endocrine and metabolic emergencies: hypercalcaemia. Ther Adv Endocrinol Metab 1:225–234. https://doi.org/10.1177/2042018810390260
Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A (2013) Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008618.pub2
Bergland A, Thorsen H, Karesen R (2011) Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int 22:1863–1871. https://doi.org/10.1007/s00198-010-1435-7
Malmros B, Mortensen L, Jensen MB, Charles P (1998) Positive effects of physiotherapy on chronic pain and performance in osteoporosis. Osteoporos Int 8:215–221. https://doi.org/10.1007/s001980050057
Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int 14:677–682. https://doi.org/10.1007/s00198-003-1423-2
Yang LH, Cheng-qi H, Lei Z, Xie W, Lan Q (2007) Effect of pain-free exercises on female osteoporosis patients with spinal compressive fracture. J Clin Rehabil Tissue Eng Res 11:9108–9111
Pfeifer M, Kohlwey L, Begerow B, Minne HW (2011) Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil 90:805–815. https://doi.org/10.1097/PHM.0b013e31821f6df3
Bautmans I, Van Arken J, Van Mackelenberg M, Mets T (2010) Rehabilitation using manual mobilization for thoracic kyphosis in elderly postmenopausal patients with osteoporosis. J Rehabil Med 42:129–135. https://doi.org/10.2340/16501977-0486
Bennell KL, Matthews B, Greig A, Briggs A, Kelly A, Sherburn M, Larsen J, Wark J (2010) Effects of an exercise and manual therapy program on physical impairments, function and quality-of-life in people with osteoporotic vertebral fracture: a randomised, single-blind controlled pilot trial. BMC Musculoskelet Disord 11:36. https://doi.org/10.1186/1471-2474-11-36
Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW (2004) Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc 52:1471–1478. https://doi.org/10.1111/j.1532-5415.2004.52409.x
World Health Organization (2012) Scoping document for WHO guidelines for the pharmacological treatment of persisting pain in adults with medical illnesses. In: Pain TGo (ed). http://www.who.int/medicines/areas/quality_safety/Scoping_WHO_GLs_PersistPainAdults_webversion.pdf?ua=1. Accessed 5 Feb 2017
Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, Mierzwinski-Urban M, Clifford T, Hutton B, Rabb D (2012) The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care 28:138–144. https://doi.org/10.1017/s0266462312000086
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
The Global Spine Care Initiative and this study were funded by grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
Conflict of interest
AA declares no COI. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. PC declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care; Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance; Financial Services Commission of Ontario; Ontario Trillium Foundation, ELIB Mitac; Fond de Recherche and Sante du Quebec. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care; Clinical Policy Advisory Board and stock holder, Palladian Health; Advisory Board, SpineHealth.com; Book Royalties, McGraw Hill; Travel expense reimbursement—CMCC Board. RC declares funding from AHRQ to conduct systematic reviews on treatments for low back pain within last 2 years. Honoraria for speaking at numerous meetings of professional societies and non-profit groups on topics related to low back pain (no industry sponsored talks). EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences Data and Safety Monitoring Committee; Chair, Palmer Center for Chiropractic Research; Research Committee Co-chair, World Spine Care. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee; Palladian Health, Clinical Policy Advisory Board member; Book Royalties Wolters Kluwer and Springer; Honoraria for speaking at research method courses. JJW declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. HR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. ATV declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ameis, A., Randhawa, K., Yu, H. et al. The Global Spine Care Initiative: a review of reviews and recommendations for the non-invasive management of acute osteoporotic vertebral compression fracture pain in low- and middle-income communities. Eur Spine J 27 (Suppl 6), 861–869 (2018). https://doi.org/10.1007/s00586-017-5273-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-017-5273-6