Diagnosis and management of vertebral fractures in elderly adults

Papaioannou, Alexandra; Watts, Nelson B; Kendler, David L; Yuen, Chui Kin; Adachi, Jonathan D; Ferko, Nicole

« Previous Next »The American Journal of Medicine
Volume 113, Issue 3 , Pages 220-228, 15 August 2002

Diagnosis and management of vertebral fractures in elderly adults

Alexandra Papaioannou, MD
- Department of Medicine, Division of Geriatric Medicine (AP) McMaster University, Hamilton, Ontario, Canada
- Requests for reprints should be addressed to Alexandra Papaioannou, MD, Hamilton Health Sciences – Chedoke Site, Wilcox Building, Box 2000, Station A, Chedoke Campus, Sanatorium Road, Hamilton, Ontario L8N 3Z5, Canada
Nelson B Watts, MD
- Department of Medicine (NBW), University of Cincinnati, Cincinnati, Ohio, USA
David L Kendler, MD
- Department of Medicine (DLK), Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
Chui Kin Yuen, MD
- Department of Obstetrics (CKY), Gynecology and Reproductive Sciences, Department of Continuing Medical Education, University of Manitoba, Winnipeg, Manitoba, Canada
Jonathan D Adachi, MD
- Division of Rheumatology (JDA), McMaster University, Hamilton, Ontario, Canada
Nicole Ferko
- Department of Clinical Health Sciences (NF), McMaster University, Hamilton, Ontario, Canada

Received 4 January 2002; received in revised form 8 April 2002; accepted 22 April 2002.

Abstract

We reviewed the epidemiology, diagnosis, and treatment of vertebral fractures due to osteoporosis in the elderly. Vertebral fractures are underdiagnosed despite their high prevalence in both men and women. Clinical consequences of vertebral fractures include increased risk of future vertebral and hip fracture, acute and chronic back pain, decreased quality of life, and increased mortality. Patients with vertebral fractures have functional impairment and increased mortality similar to those with hip fractures. Asymptomatic fractures identified on radiograph also affect quality of life and mortality. A vertebral fracture is a clinical marker for a subsequent fracture and should trigger assessment and diagnosis of osteoporosis. The care of patients with vertebral fractures includes pain management, rehabilitation, and prevention of further fractures. There is evidence from randomized controlled trials that pharmacologic therapy can reduce the risk of future fractures by 40% to 50%. Vertebroplasty may be effective in the control of pain and in obtaining stability of the spine.

Keywords: Elderly, osteoporosis, vertebral fractures, pain management