Comprehensive Management of Osteoporotic Thoracic and Lumbar Vertebral Compression Fractures

Abstract

Osteoporosis (OPO) is defi ned as a disease process characterized by low bone mineral density (BMD) with accompanying microarchitectural deterioration of osseous tissue, leading to increased bone fragility and consequent increased fracture risk. The World Health Organization (WHO) originally defined 4 categories of BMD with the following criteria: normal (T-score, ≥−1.0), osteopenia (OP) (T-score, −2.5 to ≤−1.0), OPO (T-score, ≤−2.5), and severe OPO (T-score, ≤−2.5, with history of fragility fracture). Fragility fractures (FFs) are defi ned as fractures that result from a fall from standing height or less or that present in the absence of trauma. The most common sites of FF are femoral neck/hip, wrist, spine (thoracic/lumbar most common), humerus, pelvis, and forearm. Because the risk of FF is an important aspect of patient management, the WHO revised its criteria to include BMD and the patient-specifi c 10-year probability of sustaining a major FF. The 10-year probability of FF can be assessed using the Fracture Risk Assessment Tool (FRAX), which stratifi es risk according to ethnicity, age, sex, weight, height, fracture history, family history of femoral neck/hip fracture, current smoking status, history of glucocorticoid use, history of rheumatoid arthritis, history of secondary OPO, history of alcohol consumption 3 units or more (beverages)/day, and femoral neck/hip BMD (g/cm3). WHO criteria for intervention, which is defi ned as medical/pharmacologic management of BMD, are history of femoral neck/hip or spine FF at 40 years and older, BMD T-score −2.5 or less, or BMD T-score −2.5 to −1.0 or less, with an elevated FRAX of 20% or more for nonfemoral neck/hip major FF and/or 3% or more for femoral neck/hip FF. With an aging population, OPO poses an immense public health problem, with 16.2% of adults (5.1% men and 24.5% women) 65 years and older affected (2010 data, www. cdc.gov). With 47.8 million people 65 years and older living in the United States (2015 data, www.census.gov), a potential