Department of Medicine, Marshfield Medical Center, Marshfield, Wisconsin, USA.
Department of Medicine, University of Connecticut, CT, USA.
Clin Med Res. 2022 Jun;20(2):95-106. doi: 10.3121/cmr.2021.1612. Epub 2022 Apr 27.
Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.
治疗骨质疏松性和低骨量性脊柱骨折的医生应该了解其发病机制和现行的骨密度降低管理指南，因为全球骨折预防活动在实现目标方面落后了。本文是一篇叙述性综述，探讨了用于诊断骨质疏松性骨折的各种影像学和实验室检查方法，以及对当代医学和手术治疗的全面汇编。我们整合了来自内分泌学会、美国临床内分泌医师协会（AACE）和美国骨矿研究学会（ASBMR）的重要建议。强调了使用现代评分系统（如 FRAX®）评估骨质疏松症的骨折风险，包括 10 年内髋部骨折和脊柱、前臂、髋部或肩部主要骨折的风险。这种骨质疏松症风险评估工具可以很容易地纳入术前骨骼健康优化策略中，特别是在骨质疏松症患者进行择期脊柱手术之前。描述了原发性手术干预治疗椎体压缩性骨折和继发性骨折预防的药物治疗作用，以及基于随机临床试验的关于其时机和剂量、药物假期、不良反应和相关循证文献的智慧。我们还旨在为治疗老年创伤患者的骨质疏松性椎体压缩性骨折、肿瘤性骨质疏松症或硬件稳定提供基于证据的临床管理算法，同时考虑到其骨骼健康受损的情况。本文涵盖了各种医学协会关于手术干预的最新指南和建议，以及研究结果，这些结果揭示了经皮椎体成形术和球囊扩张椎体后凸成形术在老年人群中对椎体压缩性骨折进行骨水泥强化的疗效优于保守的药物治疗。
