How to Treat the Patients with Osteoporotic Vertebral Fracture?

Most osteoporotic vertebral fracture cases occur asymptomatically and heal spontaneously. However, in certain cases, vertebral collapse occurs, resulting in delayed neurological and visceral deficits, back pain, and significant activities of daily living (ADL) impairment. The basic treatment policy for osteoporotic vertebral fractures is conservative treatment using a brace and medication for osteoporosis. Nonetheless, in the case of high risk of vertebral collapse, vertebral body collapse could be prevented by considering vertebral reconstruction, such as BKP and VBS. If vertebral collapse progresses and symptoms would reduce the ADL of the patient, instrumentation surgery should be performed to improve their symptoms. When opting for instrumentation surgery, the most important parameter is to diagnose whether the cause of the disorder is failed union, spinal deformity, or nerve compression. Even after the surgery is completed, the risk of secondary complications, such as instrumentation failure and adjacent-level fracture from osteoporosis itself, persists. Therefore, it is necessary to explain to the patient and family that bracing and osteoporosis treatment will be continued after surgery and that a long-term follow-up would be required.