Bolton K, Wallis JA, Taylor NF. Benefits and harms of non-surgical and non-pharmacological management of osteoporotic vertebral fractures: A systematic review and meta-analysis.
Braz J Phys Ther 2022;
26:100383. [PMID:
35063701 PMCID:
PMC8784306 DOI:
10.1016/j.bjpt.2021.100383]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/17/2021] [Accepted: 12/17/2021] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND
Osteoporotic vertebral fractures affect a large number of older adults OBJECTIVES: Systematically review evidence of the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with standard care (control); and evaluate the benefits and harms of non-surgical and non-pharmacological management of people with osteoporotic vertebral fractures compared with an alternative non-pharmacological, non-invasive intervention.
DESIGN
Systematic review and meta-analysis of randomized controlled trials. Five electronic databases (CINAHL, EMBASE, MEDLINE, PUBMED, and COCHRANE) were searched. Eligible trials included participants with primary osteoporosis and at least one vertebral fracture diagnosed on radiographs, with treatment that was non-surgical and non-pharmacological involving more than one session.
RESULTS
Twenty randomized controlled trials were included with 2083 participants with osteoporotic vertebral fractures. Exercise, bracing, multimodal therapy, electrotherapy, and taping were investigated interventions. Meta-analyses provided low certainty evidence that exercise interventions compared to no exercise were effective in reducing pain in patients with osteoporotic vertebral fractures (mean difference (MD)= 1.01; 95% confidence interval (CI): 0.08, 1.93), and low certainty evidence that rigid bracing intervention compared with no bracing was effective in reducing pain in patients with osteoporotic vertebral fractures (MD= 2.61; 95%CI: 0.95, 4.27). Meta-analyses showed no differences in harms between exercise and no exercise groups. No health-related quality of life or activity improvements were demonstrated for exercise interventions, bracing, electrotherapy, or multimodal interventions.
CONCLUSIONS
Exercise and rigid bracing as management for patients with osteoporotic vertebral fractures may have a small benefit for pain without increasing risk of harm.
TRIAL REGISTRATION
PROSPERO registration number CRD42012002936.
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