Conservative treatments for non-surgically managed osteoporotic vertebral compression fractures: a network meta-analysis of long-term pain and quality of life

The aim of this systematic review and network meta-analysis was to evaluate and rank the long-term effectiveness of conservative interventions for osteoporotic vertebral compression fractures (OVCFs). Teriparatide demonstrated the greatest efficacy for both pain relief and quality of life improvement, significantly outperforming other non-surgical options. These results highlight the superior benefit of specific pharmacological therapies over other conservative strategies for long-term patient outcomes. PURPOSE: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of pain, disability, and poor quality of life (QoL) in the elderly population. Although non-surgical interventions are widely used, long-term comparative evidence remains limited. This study aimed to conduct a systematic review and network meta-analysis (NMA) to evaluate and rank the long-term (≥ 6 months) effectiveness of conservative interventions for OVCFs in terms of pain relief and QoL improvement. METHODS: Following PRISMA-NMA guidelines, five databases were searched for randomized controlled trials involving adults (≥ 50 years) with radiographically confirmed OVCFs. Interventions included pharmacologic therapies (e.g., teriparatide, denosumab), exercise, manual therapy, and combination strategies. Outcomes were standardized across studies and analyzed using a frequentist random-effects model. RESULTS: Twelve full articles (n = 1512) met the inclusion criteria. Teriparatide demonstrated the greatest effect on pain reduction (SMD: - 1.75; 95% CI: - 3.10 to - 0.39) and QoL improvement (SMD: + 3.90; 95% CI: 2.33 to 5.47). Denosumab showed moderate QoL benefit (SMD: + 3.47), while other interventions yielded smaller or non-significant effects. CONCLUSION: Teriparatide is the most effective non-surgical intervention for long-term pain and QoL outcomes in OVCF patients. These findings support a personalized approach to conservative care and underscore the need for high-quality trials with standardized protocols and functional endpoints.