Efficacy of Conservative management in the treatment of osteoporotic vertebral compression fractures in post-menopausal female

Abstract

Introduction: Osteoporosis is a silent disorder, and usually, back pain due to the painful vertebral compression fracture(VCF) may be the initial manifestation. Symptomatic VCF, if left untreated or ill-managed, may result in significant morbidity and mortality. It may result in chronic back pain, spinal deformity and restrictive lung diseases. Post-menopausal females are vulnerable to developed osteoporotic VCF, which can be treated surgically or conservatively. With this study , we evaluated the efficacy of conservative treatment of acute VCF in post-menopausal females. Methods & Material: Total 47 post-menopausal females (age group 50- 75years) presented to our outdoor and emergency department, between Jan 2018 to Jan 2020, with diagnosed acute VCF were recruited in our study. All patients underwent bone mineral density assessment through dual-energy X-ray absorptiometry (DXA) scan. Patients were evaluated clinically, haematologically and radiologically. All patients were treated initially with bed rest, analgesics, hyper-extension bracing, supervised physical therapy programme and education. Patients were given Calcitonin nasal spray for two months, weekly alendronate(70mg) with daily calcium(1000mg) and weekly Vitamin D(60000 unit). All patients were followed up clinically, and functional outcome was evaluated by Oswestry Disability Index (ODI). Failure of treatment was defined as persistence of VAS score of 5 or more after two month of conservative treatment. Results: 47 post-menopausal females with mean age 62.9 ± 8.6 years and mean BMD spine 0.76±0.09 gm/cm2 were followed up for a minimum of one year. At the final follow up of one year, there was a significant improvement in VAS score(p<.001) from 8.7 to 2.1 and ODI (p<.001) from 58.8 to 26 from baseline. All patients except nine showed a gradual reduction in VAS score and ODI score at successive follow-up. At final follow up the majority of patients had minimal or moderate disability(72.37%). Nine patients(21.42%) failed to respond to conservative treatment. Conclusion: We observed good results with conservative management in osteoporotic VCF that alleviate pain, reduce the risk of deformity and subsequently help in improving quality of life. We recommend conservative management should be tried first and for an adequate duration before stepping towards operative interventions.