IMPORTANCE: Osteoporotic vertebral compression fractures (VCFs) frequently cause substantial pain and reduced mobility, posing a major health problem. Despite the critical need for effective pain management to restore functionality and improve patient outcomes, the value of various conservative treatments for acute VCF has not been systematically investigated.
OBJECTIVE: To assess and compare different conservative treatment options in managing acute pain related to VCF.
DATA SOURCES: On May 16, 2023, 4 databases-PubMed, Embase, Scopus, and CINAHL-were searched. In addition, a gray literature search within Scopus and Embase was also conducted.
STUDY SELECTION: Included studies were prospective comparative and randomized clinical trials that assessed conservative treatments for acute VCF.
DATA EXTRACTION AND SYNTHESIS: Data extraction and synthesis were performed by 2 authors according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses recommendations. A frequentist graph-theoretical model and a random-effects model were applied for the meta-analysis.
MAIN OUTCOMES AND MEASURES: 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: The study included 20 trials, encompassing 2102 patients, and evaluated various interventions for managing VCF. Calcitonin (standardized mean difference [SMD], -4.86; 95% CI, -6.87 to -2.86) and nonsteroidal anti-inflammatory drugs (NSAIDs; SMD, -3.94; 95% CI, -7.30 to -0.58) were beneficial regarding short-term pain during activity compared with placebo. For long-term nonspecific pain management, bisphosphonates were associated with inferior pain outcomes compared with daily (SMD, 1.21; 95% CI, 0.11 to 2.31) or weekly (SMD, 1.13; 95% CI, 0.05 to 2.21) administration of teriparatide, with no treatment being superior to NSAIDs. The qualitative analysis of adverse events highlighted that typical adverse events associated with these medications were observed.
CONCLUSIONS AND RELEVANCE: NSAIDs and teriparatide may be the preferred treatment options for pain management in acute osteoporotic VCF. Although calcitonin also proved to be beneficial, its safety profile and potential adverse effects restrict its widespread application. The limited evidence on braces and analgesics underscores the urgent need for future research.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Nurse | |
Physician rater
The effective therapies for this use are not available where I practice.
Physician rater
This NMA is very interesting in that it highlights the paucity of studies and level of evidence on which treatment decisions for this clinical issue are based. It highlights the need for further evaluation of NSAIDs, teriparatide, and many of the new anti-osteoporotic agents.
Physician rater
Useful article.
Physician rater
These results are likely not known by all clinicians who encounter these patients and attempt to help manage the related acute and potentially related chronic pain. Although many are aware of teriparatide’s role in osteoporosis, fewer clinicians seem to be aware of its role in compression fracture pain. Similarly, many may mistakenly overestimate the benefits of bisphosphonates and PT. Lastly, this study also helps reinforce the need for additional vigorous high-quality studies exploring this area.
, McMaster University