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Eur Spine J. 2018 Sep;27(Suppl 6):861-869. doi: 10.1007/s00586-017-5273-6. Epub 2017 Oct 16.

The Global Spine Care Initiative: a review of reviews and recommendations for the non-invasive management of acute osteoporotic vertebral compression fracture pain in low- and middle-income communities.

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University of Montreal Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, Montreal, QC, Canada.
Canadian Society of Medical Evaluators, Toronto, ON, Canada.
University of Ontario Institute of Technology (UOIT)-Canadian Memorial Chiropractic College (CMCC) Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada.
Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, USA.
Department of Neurology, University of California, Irvine, USA.
World Spine Care, Santa Ana, CA, USA.
Department of Medical Informatics and Clinical Epidemiology and Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.
Department of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.
World Spine Care Europe, Holmfirth, UK.



The purpose of this review was to develop recommendations for non-invasive management of pain due to osteoporotic vertebral compression fractures (OVCF) that could be applied in medically underserved areas and low- and middle-income countries.


We conducted a systematic review and best evidence synthesis of systematic reviews on the non-invasive management of OVCF. Eligible reviews were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Low risk of bias systematic reviews and high-quality primary studies that were identified in the reviews were used to develop recommendations.


From 6 low risk of bias systematic reviews and 14 high-quality primary studies we established that for acute pain management, in addition to rest and analgesic medication, orthoses may provide temporary pain relief, in addition to early mobilization. Calcitonin can be considered as a supplement to analgesics; however, cost is of concern. Once acute pain control is achieved, exercise can be effective for improving function and quality of life.


The findings from this study will help to inform the GSCI care pathway and model of care for use in medically underserved areas and low- and middle-income countries. Conservative management of acute pain and recovery of function in adults with OVCF should include early mobilization, exercise, spinal orthosis for pain relief, and calcitonin for analgesic-refractory acute pain. These slides can be retrieved under Electronic Supplementary Material.


Compression; Conservative treatment; Early medical intervention; Fractures; Osteoporosis; Review literature as topic; Spine


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