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International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures

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Abstract

Summary/Rationale

We identified a knowledge gap in the non-pharmacological and non-surgical management of osteoporotic vertebral fractures.

Main results

This international consensus process established multidisciplinary biopsychosocial recommendations on pain, nutrition, safe movement, and exercise for individuals with acute and chronic vertebral fractures.

Significance

These recommendations will guide clinical practice and inform interventions for future research.

Purpose

To establish international consensus on recommendations for the non-pharmacological and non-surgical management of osteoporotic vertebral fractures.

Methods

We adopted a five-step modified Delphi consensus process: (1) literature search and content analysis, (2) creation of the survey, (3) selection of the expert panel, (4) first round of the rating process, and (5) second round of the rating process. The first round included 49 statements and eight open-ended questions; the second round included 30 statements. Panelists were asked to rate their agreement with each of the statements using a 9-point scale, with the option to provide further comments. Consensus for each statement was determined by counting the number of panelists whose rating was outside the 3-point region containing the median.

Results

We invited 76 people with degree in medicine, physiotherapy, kinesiology, and experience in the management of osteoporotic vertebral; 31 (41%) and 27 (36%) experts agreed to participate to the first and the second round, respectively. The mean percentage agreement after the first and second rounds was 76.6% ± 16.0% and 90.7% ± 6.5%, respectively. We established consensus on recommendations on pain, early satiety, weight loss, bracing, safe movement, and exercise for individuals with acute and chronic vertebral fractures.

Conclusion

Our international consensus provides multidisciplinary biopsychosocial recommendations to guide the management of osteoporotic vertebral fractures and inform interventions for future research.

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Acknowledgements

The authors thank all the panelists who participated to the rating process. The following provided consent to be mentioned as contributors (listed in alphabetical order by first name): Amanda Isaac, MBChB, MRCS, FRCR, Consultant Musculoskeletal and Spine Radiologist, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, England; Andrew Briggs, PhD FACP, Professor, Curtin University, Perth, Australia; Anette Ranhoff, MD PhD, Professor, University of Bergen, Bergen, Norway; Belinda Beck, PhD, Professor, Griffith University, Gold Coast & The Bone Clinic, Brisbane, Australia; Bonny O’Hare, BScPT, Clinical Physiotherapist, Director: Pro Motion Physiotherapy, Osteo-Circuit, Canada; Carleen Lindsey, PT, MScAH, GCS, Bones, Backs and Balance, LLC, New Hartford, CT, USA; David J Armstrong, MD, FRCP(Edin), Consultant Rheumatologist and Clinical Lead for Osteoporosis & Fracture Liaison, Western Health and Social Care Trust, Londonderry, Northern Ireland; Debra Butt, MD, MSc, Associate Professor, University of Toronto, Toronto and Scarborough Health Network, Scarborough, Canada; Emma Clark, Professor, Bristol Medical School, University of Bristol, Bristol, England; Jenny Thain, MD, FRCP, Geriatrician, Assistant Professor, Division of Geriatric Medicine, Western University, London, Canada; Karen Barker, OBE, PhD, FCSP, Professor of physiotherapy, University of Oxford, Oxford, England; Palina Karakasidou, PT, OMT, MSc, MManipTher, PhD, Assistant Professor, University of West Attica, Athens, Greece; Phil Chilibeck, PhD, Professor, College of Kinesiology, University of Saskatchewan, Saskatoon, Canada; Sarah Hardcastle, MBChB, BSc, MRCP (UK), PhD, Royal National Hospital for Rheumatic Diseases, Bath, England; Sharon Marr, BSc, MD, FRCPC, MED, Associate Professor, Geriatric Medicine, Department of Medicine University of Toronto & Medical Director of Seniors Health, St. Michael’s Hospital Department of Medicine and Providence Healthcare, Unity Health Toronto, Canada; Thomas Thierry, MD, Head of Rheumatology Department, St-Etienne University Hospital, St-Etienne, France; and Wendy Katzman, PT, DPTSc, OCS, Professor Emeritus, University of California San Francisco, San Francisco, USA. Sixteen additional respondents did not specify that they wished to be named. The authors thank Angel Ong, PhD, RD, and Genevieve Mailhot, PhD, RD, Professor, Department of Nutrition, Université Montréal, Montréal, Canada, for reviewing the recommendations on nutrition. Sixteen additional panelists and one dietitian did not specify that they wished to be named.

Funding

This study was funded by the CIHR-IMHA Canadian Musculoskeletal Rehab Research Network (grant #: CIHR FRN: CFI-148081). We acknowledge the support of the Natural Sciences and Engineering Research Council of Canada (NSERC), CREATE 509950–2018 Training in Global Biomedical Technology Research and Innovation.

Author information

Authors and Affiliations

  1. School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan Campus, 1238 Discovery Avenue, Kelowna, BC, V1V 1V9, Canada

    Matteo Ponzano

  2. International Collaboration On Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada

    Matteo Ponzano

  3. Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2T0G6, Canada

    N. Tibert, H. Keller & L. M. Giangregorio

  4. Canadian Osteoporosis Patient Network, Osteoporosis Canada, 201 – 250 Ferrand Dr, Toronto, ON, M3C 3G8, Canada

    S. Brien & L. Funnell

  5. Department of Kinesiology and Physical Activity, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada

    J. C. Gibbs

  6. Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada

    H. Keller & L. M. Giangregorio

  7. Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5S, Canada

    J. Laprade

  8. Department of Medicine, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada

    S. N. Morin

  9. Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S4L8, Canada

    A. Papaioannou

  10. Canadian Society for Exercise Physiology (CSEP), Ottawa, Canada

    Z. Weston

  11. Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L3C5, Canada

    Z. Weston

  12. School of Physical & Occupational Therapy, McGill University, 845 Rue Sherbrooke O, Montréal, QC, H3A0G4, Canada

    T. H. Wideman

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  1. Matteo Ponzano
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  2. N. Tibert
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  4. L. Funnell
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  5. J. C. Gibbs
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  6. H. Keller
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  7. J. Laprade
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  8. S. N. Morin
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  9. A. Papaioannou
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  10. Z. Weston
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  11. T. H. Wideman
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  12. L. M. Giangregorio
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Corresponding author

Correspondence to Matteo Ponzano.

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This study received ethics approval from the University of Waterloo Research Ethics Board (ORE #43154).

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The original online version of this article was revised: In Boxes 2, 4, 5, and 6 of this article, the data were mistakenly listed in the wrong rows. The original article has been corrected.

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Ponzano, M., Tibert, N., Brien, S. et al. International consensus on the non-pharmacological and non-surgical management of osteoporotic vertebral fractures. Osteoporos Int 34, 1065–1074 (2023). https://doi.org/10.1007/s00198-023-06688-9

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