We would like to nominate the topic Symptomatic Osteoporotic Spinal Compression Fractures as a topic for review. This is a problem which affects millions of Americans, and the appropriate treatment is still unclear. The treatment ranges from benign neglect, to bracing, to medications treating osteoporosis, to invasive surgical procedures. There is not a clearly established indication for treatment, and the literature has been conflicting. Osteoporotic compression fractures typically occur in elderly patients, but can also be present in medically ill younger patients as well. Per the American Association of Neurosurgery, an estimated 10 million Americans have osteoporosis, and 750,000 per year suffer fractures. Osteoporotic compression fractures have been found to be causative in conditions such as chronic pain, adult spinal deformity and concomitant functional decline, and even an increase in mortality. In summary, osteoporotic vertebral compression fractures are a common and serious health condition for which multiple treatments are available. The care of the patients is often complicated by conflicting data and recommendations by various authors and specialty societies. This topic is of enormous public interest and potential benefit. The goal of this topic review would include:

Increase understanding of the magnitude of the problem of osteoporosis-related vertebral fracture

Understand appropriate diagnostic modalities and develop best practice for diagnosis of acute vs chronic fractures

Increase awareness by physicians of osteoporosis, and the importance of instituting treatment once a fracture is diagnosed

Develop algorithms of treatment for the symptomatic acute fracture

References: http://www.aans.org/patient%20information/conditions%20and%20treatments/vertebral%20compression%20fractures.aspx Melton LJ 3d. Epidemiology of spinal osteoporosis. Spine. 1997;22(24 Suppl):2S 11S. Chen AT, Cohen DB, Skolasky RL. "Impact of nonoperative treatment, vertebroplasty, and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population."J Bone Joint Surg Am. 2013 Oct 22;95(19):1729-36. doi: 10.2106/JBJS.K.01649. PMID: 2408896

Osteoporosis affects millions of Americans, especially in those over 65. As the US population continues to age, the incidence of osteoporosis-related fractures will increase. Vertebral compression fractures are the most common osteoporotic related fracture. Twenty-five percent of all postmenopausal women in the United States have a compression fracture. Newer medication for osteoporosis and surgical procedures to augment the fractured vertebrae may increase cost of care, but we must ensure that the benefits are worth the cost and risk. Delving into the available data may answer these questions. A thorough systematic review would help physician and patient decision making on this complex topic.

The American Academy of Orthopaedic Surgery has previously developed guidelines on treatment of symptomatic osteoporotic compression fractures. Unfortunately, many of our recommendation were inconclusive. There has been a significant increase in volume of literature surrounding the topic of osteoporotic compression fracture since that endeavor. Better guidelines to practicing physicians would allow better informed consent process with patients. There would likely be more standardization of care and therefore, more consistently good outcomes for patients. Compression fractures represent a significant societal cost, and by identifying best practices for treatment and prevention, this research could save millions of healthcare dollars and improve the function of our patients.

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American Academy of Orthopaedic Surgeons

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Correspondence with Amanda Borsky