Noting that there appears to be no global “standard” of conservative treatment for osteoporotic vertebral fractures, researchers from Japan set out to explore the effect of initial bed rest among patients with and without poor prognostic findings on MRI.
The study, “Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures: A Prospective Cohort Study,” appears in the October 19, 2022, edition of The Journal of Bone and Joint Surgery.
As lead investigator told OTW, this study is the third that the Japan-based research team has conducted regarding vertebral fractures. According to Toru Funayama, M.D., Ph.D. “The first was a single arm feasibility study on initial hospitalization with rigorous bed rest followed by bracing and rehabilitation. Then we did a study on disuse atrophy after two-week bed rest, followed by one on imaging findings predicting the risk of conservative treatment resistance in fresh osteoporotic vertebral fractures with poor prognostic features on MRI.”
The multi-center study collected data from consecutive patients aged ≥65 years with osteoporotic vertebral fractures who had been treated within two weeks after their injury and were observed for six months. The team recruited patients who could not remain at home because of severe pain.
The group of 116 patients at one hospital rested for two weeks (with in-bed rehabilitation), while the 108 individuals at the other hospital were not instructed to rest (but allowed to move around immediately, according to their pain tolerance). Patients were then subdivided according to the presence or absence of poor prognostic MRI findings.
Forty-five patients in the rest group (including three who required surgery) and 37 patients in the no-rest group (including 9 who required surgery) had poor prognostic MRI findings.
The authors wrote, “Although the difference in the rate of transition to surgery between the rest and no-rest groups did not reach significance among all patients, the transition rate in the rest group was significantly lower in the patients with poor prognostic MRI findings. Both the bone union rate and changes in ADL [activities of daily living] were not significantly different between the rest and no-rest groups. The mean vertebral collapse progression was 6.4% in the rest group and 20.9% in the no-rest group, and the mean local kyphosis progression was 2.4° in the rest group and 8.8° in the no-rest group.”
“Hospitalized bed rest for two weeks reduced the number of patients with osteoporotic vertebral fractures who require surgery among patients with poor prognostic MRI findings,” stated Dr. Funayama to OTW. “We somewhat expected these results based on our prior study.”
“A rest period of two weeks has an excellent therapeutic effect and appears to be as safe as no rest. Therefore, this might alter prior practice. However, there are numerous countries in which a two-week hospital stay for bed rest may not be a realistic treatment option due to limited bed availability.”
Remind me not to get a vertebral fracture in Japan. Amazing that we just have our patients rest to heal a vertebral fracture. It would save our health care system millions of dollars per year. Too bad, other conditions are not treated this way.