What are the best treatments for reducing osteoporotic compression fracture pain?

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Vertebral augmentation with vertebroplasty or balloon kyphoplasty yields a small reduction in both acute and chronic pain scores in adults with osteoporotic compression fractures compared with conservative therapy or sham treatment (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs]).

When compared with placebo, usual treatment, or other analgesia, calcitonin reduces the severity and duration of pain at rest and with mobility 1 week after an osteoporotic compression fracture and with mobility at 6 months postfracture (SOR: B, meta-analysis of RCTs).




A 2015 meta-analysis of 8 RCTs compared pain reduction in adults >50 years with osteoporotic compression fractures who received either vertebral augmentation (vertebroplasty or balloon kyphoplasty; 495 patients) or conservative or sham treatment (492 patients).1 Pain was measured by the visual analog scale (VAS) periodically between 1 week and 1 year.

The study included patients of both sexes who had an acute or chronic osteoporotic vertebral compression fracture that caused pain and functional limitations in daily activities. It excluded patients with neoplasm, pre-existing chronic pain or functional disability unrelated to vertebral fractures, and vertebral fractures unaccompanied by signal changes on magnetic resonance imaging.

Vertebral augmentation resulted in small to moderate reductions in pain scores compared with placebo at 1 to 4 weeks (7 trials, 938 patients; standardized mean difference [SMD]=0.3; 95% confidence interval [CI], 0.1-0.5), 2 to 3 months (7 trials, 953 patients; SMD=0.3; 95% CI, 0.1-0.4), and 1 year (5 trials, 744 patients; SMD=0.3; 95% CI, 0.1-0.4). The study is considered low-quality because of increased heterogeneity.

Calcitonin reduces pain but with some adverse effects

A 2011 meta-analysis of 10 RCTs (467 patients) examined the analgesic effectiveness of calcitonin in adults >60 years, of either sex, with osteoporotic compression fractures who received calcitonin in the acute phase (<10 days after fracture) and chronic phase (>3 months after fracture).2 For acute fractures, pain was measured at 1, 2, 3, and 4 weeks following treatment. For chronic fractures, pain was measured at 1, 3, and 6 months post-treatment.

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