New Advances in Diagnosis and Treatment for Vertebral Fractures in Established Osteoporosis Patients

Osteoporotic vertebral fracture frequently occurs at the middle thoracic and thoracolumbar spine, which results in kyphotic deformity of the spine. Quality of life decreases significantly and mortality increases among patients having this deformity. The risk factors for this kind of fracture include low bone mineral density (BMD), past history of vertebral fractures, and high rate of bone metabolic markers. The main goal of a drug intervention is to prevent new and further vertebral fractures. Anti-bone resorption drugs such as bisphosphonates and raloxifene are agents used to treat osteroporosis. Bisphosphonates inhibit bone resorption and thereby increase bone mineral density and reduce the frequency of morphometric and clinical vertebral fractures. The effect of this drug is confirmed by examining the change of bone resorption and formation markers (NTx and BAP). Surgical treatment of vertebral fracture includes vertebroplasty and kyphoplasty in acute cases. Anterior body fusion and vertebral osteotomy (shortening) with instrumentation are used in chronic cases. In the former technique, technical complications such as spinal injury and lung embolism from bone cement should be addressed. When treating osteoporosis, selecting the most appropriate technique in accordance with bone pathogenesis is necessary