Medical Management of a Patient with an Osteoporotic Vertebral Fracture

 

Initial management:

(1) Exclude pathologic fracture due to osteomyelitis, tumor or other process.

(2) Provide analgesia, starting with NSAIDS but including opiates if pain is severe.

(3) Mobilize the patient and minimize bed rest.

(4) Consider intransal or subcutaneous calcitonin 200 IU per day for 14 days.

(5) If pain is controlled then start lifestyle and pharmacologic management of the osteoporosis.

 

where:

• Calcitonin therapy often provides significant pain relief for the patient.

 

If pain is not controlled after 6 weeks of medical management:

(1) Perform an MRI scan.

(2) Consider vertebroplasty or surgical stabilization.