Non-surgical management of osteoporotic fractures
Managing vertebral, pelvic, rib, wrist and humeral fragility fractures without surgery, analgesia that lets an older person move, when vertebroplasty doesn't help, red flags for a pathological fracture, exercise after vertebral fracture, and starting bone protection.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Most osteoporotic fractures apart from the hip are managed without surgery: vertebral, pelvic and sacral, rib, distal radius in older people, and most proximal humeral fractures.
- The aim is pain control good enough to move. Immobility causes pneumonia, pressure injury, delirium, VTE and loss of independence faster than the fracture heals.
- Vertebroplasty is no better than sham for most patients (Cochrane 2018).
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Sources
- Osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age (update of the 2017 2nd edition)AU/NZRoyal Australian College of General Practitioners and Healthy Bones Australia, 2024
- Therapeutic Guidelines: Pain and AnalgesiaAU/NZTherapeutic Guidelines Limited, 2024
- Percutaneous vertebroplasty for osteoporotic vertebral compression fracture (Buchbinder R et al. Cochrane Database Syst Rev 2018;11:CD006349)AU/NZCochrane, 2018
- A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures (Buchbinder R et al. N Engl J Med 2009;361:557-68)AU/NZNew England Journal of Medicine, 2009
- Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR) (Clark W et al. Lancet 2016;388:1408-16)AU/NZLancet, 2016
- Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture (Giangregorio LM et al. Osteoporos Int 2014;25:821-35)Osteoporosis International, 2014
- Surgical plating vs closed reduction for fractures in the distal radius in older patients (CROSSFIRE) (Lawson A et al. JAMA Netw Open 2021;4:e2036802)AU/NZJAMA Network Open, 2021
- Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus (PROFHER) (Rangan A et al. JAMA 2015;313:1037-47)JAMA, 2015
- Rib fractures in the elderly (Bulger EM et al. J Trauma 2000;48:1040-6)Journal of Trauma, 2000
- Fragility fractures of the pelvis: classification and treatment (Rommens PM, Hofmann A. Injury 2013;44:1733-44)Injury, 2013
- Nonoperative versus operative treatment for frail institutionalised older patients with a proximal femoral fracture (FRAIL-HIP) (Loggers SAI et al. JAMA Surg 2022;157:424-34)JAMA Surgery, 2022
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback