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

Abstract

Background

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.

Objectives

The aim of this work is to formulate evidence-based recommendations for the use of orthoses in osteoporotic vertebral fractures and chronic symptoms.

Methodology

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.

Results

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.

Conclusions

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.

Keywords

orthosis - osteoporosis - vertebral fractures - chronic back pain - risk of bias

Publication History

Received: 07 October 2024

Accepted after revision: 19 March 2025

Article published online:
26 May 2025

• References

• 1 Ruchholtz S, Wirtz DC. Orthopädie und Unfallchirurgie essentials – Intensivkurs zur Weiterbildung. Stuttgart: Thieme; 2019
• 2 Bartl R. Osteoporose in der Praxis Vorsorge, Diagnostik und Therapie – evidence based. Berlin, Heidelberg: Springer; 2022
• 3 Dachverband der Deutschsprachigen Wissenschaftlichen Osteologogischen Gesellschaften e. V. (DVO). S3-Leitlinie: Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern ab dem 50. Lebensjahr. AWMF-Register-Nr.: 183/001. 2023 Accessed April 11, 2025 at: https://register.awmf.org/assets/guidelines/183-001l_S3_Prophylaxe-Diagnostik-Therapie-der-Osteoporose_2023-11.pdf
• 4 Fuchs J, Scheidt-Nave C, Kuhnert R. 12-Monats-Prävalenz von Osteoporose in Deutschland. Journal of Health Monitoring 2017; 2: 61-65
• 5 Willers C, Norton N, Harvey NC. et al. Osteoporosis in Europe: a compendium of country-specific reports. Arch Osteoporos 2022; 17: 23
• 6 Greitemann B, Baumgartner R. , ed. Technische Orthopädie. 4. Stuttgart: Thieme; 2017
• 7 Greitemann B, Baumgartner R. , ed. Grundkurs Technische Orthopädie. 3. Stuttgart: Thieme; 2015.
• 8 Kweh BTS, Lee HQ, Tan T. et al. The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review. Global Spine J 2021; 11: 975-987
• 9 Goodwin VA, Hall AJ, Rogers E. et al. Orthotics and taping in the management of vertebral fractures in people with osteoporosis: a systematic review. BMJ Open 2016; 6: e010657
• 10 Sánchez-Pinto-Pinto B, Romero-Morales C, López-López D. et al. Efficacy of Bracing on Thoracic Kyphotic Angle and Functionality in Women with Osteoporosis: A Systematic Review. Medicina (Kaunas) 2022; 58: 693
• 11 Newman M, Minns Lowe C, Barker K. Spinal Orthoses for Vertebral Osteoporosis and Osteoporotic Vertebral Fracture: A Systematic Review. Arch Phys Med Rehabil 2016; 97: 1013-1025
• 12 Pfeifer M, Gehlen M, Hinz C. Rückenorthesen in der Behandlung von Wirbelkörperfrakturen bei Osteoporose. Z Rheumatol 2017; 76: 860-868
• 13 Pieroh P, Spiegl UJA, Völker A. et al. Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment. Global Spine J 2023; 13(1 Suppl.): 59S-72S
• 14 Rzewuska M, Ferreira M, McLachlan AJ. et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis. Eur Spine J 2015; 24: 702-714
• 15 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
• 16 Braun C, Schmucker C, Nothacker M. et al. Manual Bewertung des Biasrisikos in InterventionsstudienVersion 2.0. 10.05.2021 Accessed April 11, 2025 at: https://freidok.uni-freiburg.de/data/194900
• 17 Higgins JPT, Savović J, Page MJ. et al. Chapter 8: Assessing risk of bias in a randomized trialCochrane Handbook for Systematic Reviews of Interventions Version 6.4. August 2023. Accessed April 11, 2025 at: https://training.cochrane.org/handbook/current/chapter-08
• 18 Sterne JAC, Savović J, Page MJ. et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
• 19 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Online) 2016; 355: i4919
• 20 Mehrholz J. Wissenschaft erklärt: Evidenzstufen – Studien nach ihrer Qualität einordnen. ergopraxis 2010; 3: 14
• 21 Hoshino M, Tsujio T, Terai H. et al. Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976) 2013; 38: E641-E648
• 22 Raeissadat SA, Sedighipour L, Pournajaf S. et al. Effect of posture training with weighted kypho-orthosis (WKO) on improving balance in women with osteoporosis. J Aging Res 2014; 2014
• 23 Dionyssiotis Y, Trovas G, Thoma S. et al. Prospective study of spinal orthoses in women. Prosthet Orthot Int 2015; 39: 487-495
• 24 Meccariello L, Muzii VF, Falzarano G. et al. Dynamic corset versus three-point brace in the treatment of osteoporotic compression fractures of the thoracic and lumbar spine: a prospective, comparative study. Aging Clin Exp Res 2017; 29: 443-449
• 25 Bornemann R, Hanna M, Kabir K. et al. Continuing conservative care versus crossover to radiofrequency kyphoplasty: a comparative effectiveness study on the treatment of vertebral body fractures. Eur Spine J 2012; 21: 930-936
• 26 Kim HJ, Yi JM, Cho HG. et al. Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: A prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am 2014; 96: 1959-1966
• 27 Kato T, Inose H, Ichimura S. et al. Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study. J Clin Med 2019; 8: 198
• 28 Pfeifer M, Begerow B, Minne HW. Effects of a New Spinal Orthosis on Posture, Trunk Strength, and Quality of Life in Women with Postmenopausal Osteoporosis: A Randomized Trial. Am J Phys Med Rehabil 2004; 83: 177-186
• 29 Pfeifer M, Kohlwey L, Begerow B. et al. Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: A randomized trial. Am J Phys Med Rehabil 2011; 90: 805-815
• 30 Shariatzadeh H, Saeed Modaghegh B, Mirzaei A. et al. The Effect of Dynamic Hyperextension Brace on Osteoporosis and Hyperkyphosis Reduction in Postmenopausal Osteoporotic Women. Arch Bone Jt Surg 2017; 5: 181-185
• 31 Hübscher M, Schmidt K, Fink M. et al. Prospektive Evaluation funktions- und lebensqualitätsbezogener Effekte einer Wirbelsäulenorthese bei Frauen mit Osteoporose. Z Orthop Unfall 2010; 148: 443-447
• 32 Schmidt K, Hübscher M, Vogt L. et al. Einflüsse einer Wirbelsäulenorthese auf Gangparameter und Alltagsfunktion bei postmenopausaler Osteoporose. Orthopade 2012; 41: 200-205
• 33 Kaplan RS, Sinaki M. Effect of back supports on back strength in patients with osteoporosis: A pilot study. Mayo Clin Proc 1996; 71: 235-241
• 34 Li M, Law SW, Cheng J. et al. A comparison study on the efficacy of SpinoMed and soft lumbar orthosis for osteoporotic vertebral fracture. Prosthet Orthot Int 2015; 39: 270-276
• 35 Kaijser Alin C, Uzunel E, Grahn Kronhed AC. et al. Effect of treatment on back pain and back extensor strength with a spinal orthosis in older women with osteoporosis: a randomized controlled trial. Arch Osteoporos 2019; 14: 5
• 36 Kaijser Alin C, Grahn-Kronhed AC, Uzunel E. et al. Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study. Arch Rehabil Res Clin Transl 2021; 3: 100154
• 37 Kaijser Alin C, Frisendahl N, Kronhed ACG. et al. Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care. Arch Osteoporos 2020; 15: 171
• 38 Sinaki M, Lynn SG. Reducing the Risk of Falls Through Proprioceptive Dynamic Posture Training in Osteoporotic Women with Kyphotic Posturing. Am J Phys Med Rehabil 2002; 81: 241-246
• 39 Vogt L, Hübscher M, Brettmann K. et al. Postural correction by osteoporosis orthosis (Osteo-med): A randomized, placebo-controlled trial. Prosthet Orthot Int 2008; 32: 103-110
• 40 Sinaki M, Brey RH, Hughes CA. et al. Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a spinal proprioceptive extension exercise dynamic (SPEED) program. Mayo Clin Proc 2005; 80: 849-855
• 41 Furrer PR, Hodel S, Wanivenhaus F. et al. Compliance with wearing a thoracolumbar orthosis in nonoperative treatment of osteoporotic vertebral fractures: a prospective sensor-controlled study. Spine J 2023; 23: 433-439