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- Title
Conservative Treatments in the Management of Acute Painful Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis.
- Authors
Alimy, Assil-Ramin; Anastasilakis, Athanasios D.; Carey, John J.; D'Oronzo, Stella; Naciu, Anda M.; Paccou, Julien; Yavropoulou, Maria P.; Lems, Willem F.; Rolvien, Tim
- Abstract
Key Points: Question: Which conservative treatment option is most beneficial regarding pain-related outcomes in acute osteoporotic vertebral compression fractures (VCFs)? Findings: Using data from 20 trials involving 2102 patients, this systematic review and network meta-analysis evaluated conservative interventions, including bisphosphonates, calcitonin, teriparatide, nonsteroidal anti-inflammatory drugs (NSAIDs), and braces, for the treatment of acute VCF. The short-term assessment indicated that calcitonin and NSAIDs were associated with decreased pain during activity, and the long-term assessment revealed that teriparatide was associated with lower pain levels compared with bisphosphonates. Meaning: These findings and currently established treatment strategies highlight the value of NSAIDs and teriparatide in managing pain in acute VCF, while emphasizing the need for further research. This systematic review and network meta-analysis compares different conservative treatments for managing acute painful vertebral compression fractures. Importance: Osteoporotic vertebral compression fractures (VCFs) frequently cause substantial pain and reduced mobility, posing a major health problem. Despite the critical need for effective pain management to restore functionality and improve patient outcomes, the value of various conservative treatments for acute VCF has not been systematically investigated. Objective: To assess and compare different conservative treatment options in managing acute pain related to VCF. Data Sources: On May 16, 2023, 4 databases—PubMed, Embase, Scopus, and CINAHL—were searched. In addition, a gray literature search within Scopus and Embase was also conducted. Study Selection: Included studies were prospective comparative and randomized clinical trials that assessed conservative treatments for acute VCF. Data Extraction and Synthesis: Data extraction and synthesis were performed by 2 authors according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses recommendations. A frequentist graph-theoretical model and a random-effects model were applied for the meta-analysis. Main Outcomes and Measures: Primary outcomes were short-term (4 weeks) pain during activity and long-term (latest available follow-up) nonspecified pain in patients with acute VCF. Results: The study included 20 trials, encompassing 2102 patients, and evaluated various interventions for managing VCF. Calcitonin (standardized mean difference [SMD], −4.86; 95% CI, −6.87 to −2.86) and nonsteroidal anti-inflammatory drugs (NSAIDs; SMD, −3.94; 95% CI, −7.30 to −0.58) were beneficial regarding short-term pain during activity compared with placebo. For long-term nonspecific pain management, bisphosphonates were associated with inferior pain outcomes compared with daily (SMD, 1.21; 95% CI, 0.11 to 2.31) or weekly (SMD, 1.13; 95% CI, 0.05 to 2.21) administration of teriparatide, with no treatment being superior to NSAIDs. The qualitative analysis of adverse events highlighted that typical adverse events associated with these medications were observed. Conclusions and Relevance: NSAIDs and teriparatide may be the preferred treatment options for pain management in acute osteoporotic VCF. Although calcitonin also proved to be beneficial, its safety profile and potential adverse effects restrict its widespread application. The limited evidence on braces and analgesics underscores the urgent need for future research.
- Subjects
PAIN management; OSTEOPOROSIS treatment; CONSERVATIVE treatment; MEDICAL information storage &; retrieval systems; NONSTEROIDAL anti-inflammatory agents; GREY literature; DIPHOSPHONATES; TERIPARATIDE; DRUG side effects; CINAHL database; VERTEBRAL fractures; COMPRESSION fractures; TREATMENT effectiveness; META-analysis; CALCITONIN; DESCRIPTIVE statistics; BONE fractures; SYSTEMATIC reviews; MEDLINE; MATHEMATICAL models; ONLINE information services; COMPARATIVE studies; THEORY; CONFIDENCE intervals; DATA analysis software; PHYSICAL activity; DISEASE complications
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2432041
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.32041