Orthosis in the Treatment of Osteoporosis-associated Fractures and Chronic Symptoms in the Spine - a Systematic Review.

Osteoporosis is a systemic skeletal disease of multi-aetiological origin and is a major factor in health economics. The reduction in bone mass and disruption of the microarchitecture lead to an increased risk of fracture. The therapy is versatile, with orthoses being used in the treatment of acute vertebral fractures as well as chronic pain.The aim of this work is to formulate evidence-based recommendations for the use of orthoses in osteoporotic vertebral fractures and chronic symptoms.The literature search was conducted according to the PRISMA protocol at PubMed, ScienceDirect, Cochrane and Google Scholar. The risk of bias of the studies was assessed using RoB2 for randomised studies and ROBINS-I for non-randomised studies. The level of evidence was determined according to AHCPR.A total of 18 studies were identified, with 11 studies focussing on the treatment of chronic back pain in osteoporosis and 7 studies on pain therapy for acute osteoporotic vertebral fractures. The non-RCTs matched 5× to evidence levels IIa. The risk of bias was 10× moderate, 4× severe and 3× critical. The RCTs could be divided by the following evidence levels: 10× Ib, 1× IIb, 1× III and 1× IV. The risk of bias was 10× moderate and 3× critical.In the case of chronic back pain, the use of orthoses leads to a reduction in pain and has a positive effect on back extensor strength, but a significant reduction in pain cannot be achieved in osteoporosis-associated vertebral body fractures. The currently available literature do not support the superiority of a specific type of orthosis.