An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review

Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): Patrícia Parreira, Chris G. Maher, Rodrigo Z. Megale, Lyn March, Manuela L. Ferreira
Background ContextVertebral compression fractures are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision-making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory.PurposeThe aim of this study was to appraise the recommendations and methodological quality of international clinical guidelines for the management of VCFs.Study DesignThis is a systematic review of clinical guidelines for the management of vertebral compression fracture.MethodsGuidelines were selected by searching MEDLINE and PubMed, PEDro, CINAHL and EMBASE electronic databases between 2010 and 2016. We also searched clinical practice guideline databases, including the National Guideline Clearinghouse and the Canadian Medical Association InfoBase. The methodological quality of the guidelines was assessed by two authors independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument. We also classified the strength of each recommendation as either: strong (i.e. based on high quality studies with consistent findings for recommending for or against the intervention); weak (i.e based on lack of compelling evidence resulting in uncertainty for benefit or potential harm); or expert Consensus (i.e. based on expert opinion of the working group rather than scientific evidence). Guideline recommendations were grouped into diagnostic, conservative care, interventional care and osteoporosis treatment/prevention of future fractures. Our study was prospectively registered on PROSPERO. All authors have declared: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; any other relationships or activities that could appear to have influenced the submitted workResultsFour guidelines, from three countries, published in the period 2010 - 2013 were included. In general, the quality was not satisfactory (50% or less of the maximum possible score). The domains scoring 50% or less of the maximum possible score were rigor of development, clarity of presentation and applicability. Use of plain radiography or dual-energy x-ray absorptiometry for diagnosis was recommended in two of the four guidelines. Vertebroplasty or kyphoplasty were recommended in 3 of the 4 guidelines. The recommendation for bed rest, trunk orthoses, electrical stimulation and supervised or unsupervised exercise was inconsistent across included guidelines.ConclusionsThe comparison of clinical guidelines for the management of VCF showed that diagnostic and therapeutic recommendations were generally inconsistent. The evidence available to guideline developers was limited in quantity and quality. Greater efforts are needed to improve the quality of the majority of guidelines.



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