How to Diagnose and Manage Vertebral Compression Fractures in the ED

With Robert Dachs

In this episode, Dr. Shenvi is joined by Dr. Dachs for a conversation about vertebral compression fractures. Dr. Dachs worked in rural EDs for over 3 decades and is now the Assistant Director of the Dept. of Emergency Medicine at Ellis Hospital in upstate New York.

Learn about who is at risk of getting a vertebral compression fracture, how they present, what evaluation is needed, and how to prevent a future fracture.

Key Points About Vertebral Compression Fractures

  • They are the most common type of fragility fracture and about 2/3 of them are asymptomatic
  • They can occur with minor trauma, especially in women and those with or those at risk of osteoporosis or osteopenia
  • The most common locations are T10 to L2
  • There are several early and late associated complications that ED clinicians need to be able to address
  • It is important to look for any signs that the injury may be more than just a vertebral compression fracture
  • Pain management:
    • Appropriate analgesics plus nasal calcitonin
    • Evidence for bracing is inconclusive
    • Referral to physiotherapy to develop strength and prevent future falls
  • Prevent future falls:
    • Start Ca++ intake 1000-1200mg a day
    • Start Vitamin D 600 – 800mg a day
    • Start bisphosphonates

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