Clin Osteol 2026; 31(1): 55-64 | DOI: 10.36290/clo.2026.008

Diagnosis and treatment of osteoporotic vertebral fracturesReview articles

Martin Bibza1, Michal Božík1, Mário Malina1, Boris Šteňo2
1 I. ortopedicko-traumatologická klinika LF UK a UNB, Nemocnica Ružinov, Bratislava
2 II. ortopedicko-traumatologická klinika LF UK a UNB, Nemocnica sv. Cyrila a Metoda, Bratislava

Osteoporotic vertebral compression fractures represent the most common clinical manifestation of osteoporosis and a major cause of morbidity in the elderly population. Successful management requires accurate identification of fractures, differentiation between acute and chronic fractures, assessment of stability, and comprehensive evaluation of functional status and frailty. The AO Spine-DGOU classification and Osteoporotic Fracture (OF) score provide a structured framework for assessing fracture morphology and guide decision-making between conservative treatment and surgical procedures. Conservative therapy is appropriate for stable fractures without neurological deficits; cement augmentation is indicated for painful fractures unresponsive to conservative management when local anatomical conditions are favorable; and stabilization is required in cases of instability, deformity progression, or neurological impairment. Long-term outcomes depend on adequate systemic osteoporosis treatment and a coordinated multidisciplinary approach.

Keywords: kyphoplasty, osteoporosis, osteoporotic vertebral fracture, spinal stabilization, spine surgery, vertebroplasty.

Accepted: March 25, 2026; Published: March 30, 2026  Show citation

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Bibza M, Božík M, Malina M, Šteňo B. Diagnosis and treatment of osteoporotic vertebral fractures. Clinical Osteology. 2026;31(1):55-64. doi: 10.36290/clo.2026.008.
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    References

    1. Payer J, Killinger Z, Jackuliak P, et al. Osteoporóza - štandardný diagnostický a terapeutický postup. 1. revízia. Ministerstvo zdravotníctva SR: Bratislava 2023.
    2. Jang HD, Kim EH, Lee JC, et al. Management of osteoporotic vertebral fracture: review update 2022. Asian Spine J. 2022;16(6):934-946. Go to original source... Go to PubMed...
    3. Tosteson ANA, Gabriel SE, Grove MR, et al. Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int. 2001;12(12):1042-1049. Go to original source... Go to PubMed...
    4. Al Taha K, Lauper N, Bauer DE, et al. Multidisciplinary and coordinated management of osteoporotic vertebral compression fractures: current state of the art. J Clin Med. 2024;13(4):930. Go to original source... Go to PubMed...
    5. Malacon K, Beach I, Touponse G, et al. Trends in management of osteoporosis following primary vertebral compression fracture. J Endocr Soc. 2023;7(7):bvad085. Go to original source... Go to PubMed...
    6. Dimar J, Bisson EF, Dhall S, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines for perioperative spine: preoperative osteoporosis assessment. Neurosurgery. 2021;89(Suppl 1):S19-S25. Go to original source... Go to PubMed...
    7. Sardar ZM, Coury JR, Cerpa M, et al. Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction. Spine. 2022;47(2):128-135. Go to original source... Go to PubMed...
    8. Anderson PA, Binkley NC, Bernatz JT. Bone health optimization in spine surgery. Spine 2023;48(11):782-790. Go to original source... Go to PubMed...
    9. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Go to original source... Go to PubMed...
    10. Daskalakis II, Bastian JD, Mavrogenis AF, et al. Osteoporotic vertebral fractures: an update. SICOT J. 2025;11:40. Go to original source... Go to PubMed...
    11. Raad M, Kim AH, Durand WM, et al. Low bone mineral density: a primer for the spine surgeon. Spine Deform. 2024;12(6):1511-1520. Go to original source... Go to PubMed...
    12. Hou Z, Gao Y, Ding S, et al. Diagnostic efficiency of chest CT for opportunistic screening for osteoporosis and low BMD in postmenopausal women. Sci Rep. 2025;15(1):32739. Go to original source... Go to PubMed...
    13. Yang H, Yan S, Li J, et al. Prediction of acute versus chronic osteoporotic vertebral fracture using radiomics-clinical model on CT. Eur J Radiol. 2022;149:110197. Go to original source... Go to PubMed...
    14. Gotta J, Koch V, Mahmoudi S, et al. Opportunistic osteoporosis assessment from routine CT - effect of intravenous contrast agents on absolute values, T-scores, and derived classifications in single- and dual-energy CT. Eur Radiol. 2025;36(3):2135-2146. Go to original source... Go to PubMed...
    15. Leonhardt Y, May P, Gordijenko O, et al. Opportunistic QCT bone mineral density measurements predicting osteoporotic fractures: a use case in a prospective clinical cohort. Front Endocrinol (Lausanne). 2020;11:586352. Go to original source... Go to PubMed...
    16. Fitoussi LY, Viola Á, Aslan S, et al. From detection to decision: T-score-guided use of STIR MRI after CT in vertebral fractures. Diagnostics (Basel). 2025;15(18):2370. Go to original source... Go to PubMed...
    17. Blattert TR, Schnake KJ, Gonschorek O, et al. Nonsurgical and surgical management of osteoporotic vertebral body fractures: recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2 Suppl):50S-55S. Go to original source... Go to PubMed...
    18. Scherer J, Joaquim A, Vaccaro A, et al. AO Spine-DGOU osteoporotic fracture classification system: internal validation by the AO Spine Knowledge Forum Trauma. Global Spine J. 2025;15(4):2152-2157. Go to original source... Go to PubMed...
    19. Mitani K, Takahashi T, Tokunaga S, et al. Therapeutic prediction of osteoporotic vertebral compression fracture using the AO Spine-DGOU osteoporotic fracture classification and classification-based score. Neurospine. 2023;20(4):1166-1176. Go to original source... Go to PubMed...
    20. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148. Go to original source... Go to PubMed...
    21. Kasture A, Nene A, Patel P. Classification of osteoporotic vertebral compression fractures - current updates and how to manage them. Indian Spine J. 2025;8(2):109-113. Go to original source...
    22. Láinez Ramos-Bossini AJ, Jiménez Gutiérrez PM, Luengo Gómez D, et al. A comparative analysis of international classification systems to predict the risk of collapse in single-level osteoporotic vertebral fractures. Diagnostics (Basel). 2024;14(19):2152. Go to original source... Go to PubMed...
    23. Halvachizadeh S, Stalder AL, Bellut D, et al. Systematic review and meta-analysis of 3 treatment arms for vertebral compression fractures: a comparison of improvement in pain, adjacent-level fractures, and quality of life between vertebroplasty, kyphoplasty, and nonoperative management. JBJS Rev. 2021;9(10):e21.00045. Go to original source... Go to PubMed...
    24. Liu Y, Liu J, Suvithayasiri S, et al. Comparative efficacy of surgical interventions for osteoporotic vertebral compression fractures: a systematic review and network meta-analysis. Neurospine. 2023;20(4):1142-1158. Go to original source... Go to PubMed...
    25. Lee JT, Ko MJ, Lee BJ, et al. Pain intervention for osteoporotic compression fracture, from physical therapy to surgery: a literature review. Korean J Neurotrauma. 2024;20(3):159. Go to original source... Go to PubMed...
    26. Qiu Z, Wang P, Chao Y, et al. The risk of new vertebral fracture after percutaneous vertebral augmentation in patients suffering from single-level osteoporotic vertebral compression fractures: a meta-analysis and systematic review. Medicine (Baltimore). 2023;102(46):e35749. Go to original source... Go to PubMed...
    27. Marselou E, Kelekis A, Dimitriadis Z, et al. Risk factors for refracture or new vertebral compression fractures after percutaneous vertebroplasty: a systematic review and meta-analysis. Osteoporos Int. 2025;36(8):1297-1311. Go to original source... Go to PubMed...
    28. Wang C, Chu YW, Lv CT. Pedicle screw fixation plus cement augmentation or cement augmentation only for osteoporotic vertebral compression fracture: a systematic review and meta-analysis. World Neurosurg. 2025;197:123952. Go to original source... Go to PubMed...
    29. Qin G, Hu L, Liang Z, et al. Bone cement-augmented vs. conventional pedicle screws for osteoporotic lumbar spondylolisthesis: a meta-analysis. Front Surg. 2026;12:1692448. Go to original source... Go to PubMed...
    30. Takahashi S, Sakai D, Ogasawara S, et al. The risk of intravenous cement leakage and short-term outcomes of selective cement-augmented pedicle screws: a multicenter retrospective study. Clin Spine Surg. 2025;38(7):E419-E424. Go to original source... Go to PubMed...
    31. Dang SJ, Wei WB, Wei L, et al. Vertebroplasty combined with facet joint block vs. vertebroplasty alone in relieving acute pain of osteoporotic vertebral compression fracture: a randomized controlled clinical trial. BMC Musculoskelet Disord. 2022;23(1):807. Go to original source... Go to PubMed...
    32. Weiser L, Sellenschloh K, Püschel K, et al. Reduced cement volume does not affect screw stability in augmented pedicle screws. Eur Spine J. 2020;29(6):1297-1303. Go to original source... Go to PubMed...
    33. Bjerke BT, Zarrabian M, Aleem IS, et al. Incidence of osteoporosis-related complications following posterior lumbar fusion. Global Spine J. 2018;8(6):563-569. Go to original source... Go to PubMed...
    34. Daniels AH, Singh M, Knebel A, et al. Preoperative optimization strategies in elective spine surgery. JBJS Rev. 2025;13(2):e24.00210. Go to original source... Go to PubMed...
    35. Pikner R, Němec P, Palička V, et al. Fracture Liaison Services: Program koordinované sekundární prevence osteoporotických zlomenin. Clin Osteol. 2021;26(3):119-132. Go to original source...
    36. Němec P, Pikner R, Hejduk K, et al. Pilotní projekt FLS OSTEO - sekundární prevence osteoporotických zlomenin. Clin Osteol. 2021;26(3):133-142 Go to original source...

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