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