骨粗鬆症性椎体骨折—その対処法は？

How to Treat Osteoporotic Vertebral Fracture?

Point

・骨粗鬆症性椎体骨折（OVF）は一度生じると再骨折の頻度が高く，生命予後が悪化することが知られている．

・OVFの再発予防のため，骨粗鬆症に対する薬物治療を行う必要がある．

・OVFに対して適切なタイミングで低侵襲手術を行うことで，遅発性神経障害を予防することができる．

　In very elderly patients with low back pain, we must consider the possibility of osteoporotic vertebral fracture （OVF）. In most patients with OVF, improvement can be observed without surgical intervention. However, even after providing the best possible conservative treatment, symptom recovery is not observed in some patients, and such patients experience delayed neurological deficits due to neural compression with the proceeding deformity of the vertebral body. Moreover, it is well known that once patients have OVF, the risk of another osteoporotic fracture in them increases. The clinical course of such patients eventually results in the loss of healthy life and increased mortality. Therefore, we should initiate medical treatment for osteoporosis at the earliest possible when OVF is detected in a patient. Patients who remain symptomatic even after undergoing adequate conservative therapy are candidates for balloon kyphoplasty. However, this minimally invasive surgery has some pitfalls. Furthermore, occasionally, we have to select instrumentation surgery for patients with delayed neurological deficits. In this “super-aged society,” neurosurgeons also encounter patients with OVF not only in surgical situations but also in outpatient clinics. Thus, we should be aware about the clinical options for the management of osteoporosis.