MANAGEMENT OF COMPRESSION FRACTURES

A LITERATURE-BASED UPDATE AND SUGGESTED INTERVENTIONS

I. Introduction
A. Epidemiology, Pathology and Sequelae of Osteoporosis
1. Looking at, inside and beyond the bones
II. Recognizing Patients At Risk in the Physical Therapy Population
A. First Signs and Risk Factors for Osteoporosis
B. Risk Factors for Fracture
III. Vertebral Compression Fractures--Definitions, descriptions, epidemiology, pathology
IV. Interventions
A. General guidelines
B, Specific Recommendations from the literature
C. The Meeks’ Method
1. Acute Stage—First 3-5 Days
a) REST
b) Positioning
c) Body Mechanics
d) Pain Relief Modalities
e) Isometric Strengthening Exercises
2. Sub-Acute Stage—6-8 weeks
a) Positioning
b) Body Mechanics
c) Position Changes and Transfers
d) Pain Relief Modalities
e) Strengthening and Flexibility Exercises
f) Postural Correction
g) Balance
h) Gait Training
3. Chronic Stage
a) Positioning
b) Body Mechanics
c) Position Changes and Transfers
d) Pain Relief Modalities
e) Strengthening and Flexibility Exercises
f) Postural Correction
g) Balance
h) Gait Training
4. Goal Setting
a) Facility
1) Staff Education
2) Wheelchair Guidelines
3) Exercise Program
b) Fitness Center--Exercise Guidelines
c) Home--Home Exercise Program
5. All Stages
a) Home Care Therapy
b) Bracing Considerations
C. Contraindicated Exercises and Movements
D. Vertebroplasty and Kyphoplasty
1. Definitions & Descriptions of procedures
2. Indications
3. Literature review of results
4. Therapy indications
5. Recommendations for Therapy Management
IV. Summaries
A. Role of Physical Therapists in Changing Medical
Environment
B. Team Approach
C. Other Issues Involved—co-morbidities
 MANAGEMENT OF COMPRESSION FRACTURES
A LITERATURE-BASED UPDATE AND SUGGESTED INTERVENTIONS

REFERENCES

1. Ananthakrishnan D et al. The effect on anterior column loading due to different vertebral augmentation
techniques. Clin Biomechanics 20 (2005) 25-31.
2. Bassey EJ. Exercise for prevention of osteoporotic fracture. Age and Aging 2001; 30-S4; 29-31
3. Bean JF et al. Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabil. 2004
Jul;85(7 Suppl 3):S31-42;quiz
4. Carlier RY et al. Osteoporotic vertebral collapse: percutaneous Vertebroplasty and local kyphosis
correction. Radiology 2004; 233:891-898.
5. Crandall D et al. Acute versus chronic vertebral compression fractures treated with kyphoplasty: early
results. Spine J. 2004 Jul-Aug;4(4):418-424.
6. Davis CM. Evidence based physical therapy program for patients with osteoporosis. J. Florida Med.
Assoc. Jan 2000 Vol86, No. 1 25-30.
7. Espallargues, M et al. Identifying bone-mass related risk factors for fracture to guide bone densitometry
measurements: a systematic review of the literature. Osteoporosis Int’l. 2001. 12(10)811-22.
8. Fribourg D et al. Incidence of subsequent vertebral fracture after Kyphoplasty. Spine 2004 Oct
15;29(20):2270-6; discussion 2277.
9. Frost HM. Clinical management of the symptomatic osteoporosis patient. Symposium on the
osteoporoses. Adapted from Frost HM. Managing the skeletal pain and disability of osteoporosis.
Orth Clinics of North Am. 1972 3:561-570.
10. Fyhrie DP, Schaffler MB. Failure mechanisms in human vertebral cancellous bone. Bone 1994 Jan-
Feb;15(1):105-109.
11. Gaitanis IN. Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur
Spine J. 2004 Oct 8;
12. Gold DT, Shipp KM, Lyles KW. Managing patients with complications of osteoporosis. Endocrin Metab
Clin North Am 1998; 27(2):485-496.
13. Gold DT et al. Group treatment improves trunk strength and psychological status in older women with
vertebral fractures: results of a randomized, clinical trial. J Am Geriatr Soc. 2004 Sep;52(9):1471-8.
14. Hallberg I et al. Health-related quality of life after osteoporotic fractures. Osteoporosis Int. 2004
Oct;15(10):834-41.
15. Harrop JS. Primary and secondary osteoporosis’ incidence of subsequent vertebral compression
fractures after kyphoplasty. Spine 2004 Oct 1;29(19):2120-5.
16. Homminga J et al. Cancellous bone mechanical properties from normals and patients with hip fractures
differ on the structure level, not on the bone hard tissue level. Bone 2002 May;30(5):759-64
17. Homminga J, Van-Rietbergen B, Lochmuller EM, Weinans H, Eckstein F, Huiskes R. The osteoporotic
vertebral structure is well adapted to the loads of daily life, but not to infrequent “error” loads. Bone
2004 Mar;34(3):510-6.
18. Kado DM et al. Hyperkyphotic posture predicts mortality in older community-dwelling man and women: a
prospective study. J Am Geriatr Soc 2004 Oct;52:1662-1667.
19. Kelley GA, Kelley KS, Tran ZV. Resistance training and bone mineral density in women: A meta-
analysis of controlled trials. Am J Phys Med Rehabil 2001;80:65-77.
20. Kemler W et al. Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids
in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention
Study (EFOPS). Arch Intern Med. 2004 May 24;164(10):1084-91
21. Kerr D, Ackland T, Maslen B, Morton A, Prince R. Resistance training over 2 years increases bone mass
in calcium-replete postmenopausal women. J Bone Miner Res 2001 Jan;16(1):175-81.
22. Kim SH et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous
vertebroplasty. Acta Radiol. 2004 Jul;45(4):440-5.
23. Kroth PJ, Murray MD, McDonald CJ. Undertreatment of osteoporosis in women, based on detection of
vertebral compression fractures on chest radiography. Am J. Geriatr Pharmacother. 2004 Jun;2(2):112-8.
24. Legroux-Gerot I et al. Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous
Vertebroplasty. Clin Rheumatol. 2004 Aug;23(4):310-7.
25. Lewis, C. PT warns against flexion exercises. Advance for Physical Therapists. January 6, 1997.
26. Liliang PC et al. Percutaneou Vertebroplasty improves pain and physical functioning in elderly
osteoporotic vertebral compression fracture patients. Gerontology. 2005 Jan-Feb;51(1):34-9.
27. Lin JT, Lane JM. Osteoporosis: A review. Clinical orthopaedics and related research. Number 425, pp.
126-134.
 MANAGEMENT OF COMPRESSION FRACTURES
A LITERATURE-BASED UPDATE AND SUGGESTED INTERVENTIONS
28. Matsuyama Y et al. Vertebral reconstruction with biodegradable calcium phosphate cement in the
treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech.
2004 Aug;17(4):291-6.
29. McKercher HG, Crilly RG, Kloseck M. Osteoporosis management in long-term care. Survey of Ontario
physicians. Can Fam Physician. 2000 Nov;46:2228-35.
30. McKiernan F, Faciszewski T, Jensen R. Quality of life following Vertebroplasty. J Bone Joint Surg Am.
2004 Dec;86-A(12):2600-6.
31. Myers ER, Wilson SE. Biomechanics of osteoporosis and vertebral fracture.
Spine 1997 Dec 15;22(Suppl):25S-31S.
32. Nachemson A, Morris JM. In vivo measurements of intradiscal pressure. J Bone Jt. Surg. 46A:1077-
1092, 1964.
33. Nussbaum et al. A review of complications associated with Vertebroplasty and kyphoplasty as reported to
the Food and Drug Administration medical device related website. J Vasc Interv Radiol 2004; 15:1185-
1192.
34. Old JL and Calvert M. Vertebral compression fractures in the elderly. Am Fam Physician. 2004
Jan1;69(1):111-6.
35. Pfeifer M, Begerow B, Minne H. Effects of a new spinal orthosis on posture, trunk muscle strength and
quality of life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil
2004; Mar; 83(3):177-186
36. Pfeifer M et al. Muscoloskeletal rehabilitation in osteoporosis: a review. J Bone Miner Res. 2004
Aug;19(8):1208-14.
37. Predey TA, Sewall LE, Smith SJ. Percutaneous Vertebroplasty: new treatment for vertebral compression
fractures. Am Fam Physician. 2002 Aug 15;66(4):611-5.
38. Rockwell JC, Sorensen AM, Baker S, Leahey D, Stock JL, Michaels J, Baran DT. Weight training
decreases vertebral bone density in premenopausal women: a prospective study. J Clin Endocrinol Metab
1990 Oct;71(4):988-93.
39. Schousboe JT et al. Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of
lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom. 2002
Fall;5(3):239-46.
40. Sinaki M, Mikkelsen B. Postmenopausal spinal osteoporosis: flexion vs extension exercises. Arch Phys
Med Rehabil Vol 65, October 1984. 593-596
41. Sinaki M, Offord MS. Physical activity in postmenopausal women: effect on back muscle strength and
bone mineral density of the spine. Arch Phys Med Rehabil 1998 Apr 69:277-280.
42. Sinaki M. Critical appraisal of physical rehabilitation measures after osteoporotic vertebral fracture.
Osteoporosis Int. (2003) 14:773-779
43. Thornton MJ, Sedlak CA, Doheny MO. Height change and bone mineral density: revisited. Orthop Nurs.
2004 Sep-Oct;23(5):315-20.
44. Truumees E. Medical consequences of osteoporotic vertebral compression fractures. Instr Course Lect.
2003;52:551-8.
45. Wu SS, Lachman E, Nagler W. Current medical, rehabilitation and surgical management of vertebral
compression fractures. J Womens Health (Larchmt). 2003 Jan-Feb;12(1):17-26.