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Treatment of osteoporotic vertebral compression fracture (OVCF) is multifaceted, but most techniques (e.g. kyphoplasty, nerve blocks, jacket splints) require orthopedic consultation. For the acute care provider, OVCF pharmacotherapy begins with acetaminophen. The ability of opioids to alleviate OVCF pain is not doubted, although there is little high-level evidence addressing the subject. Meta-analysis of five RCTs evaluating calcitonin versus placebo for acute OVCF concluded that the drug significantly reduces pain, with an effect consistently identified within seven days of treatment. The reduction in pain score over that associated with placebo is both long-lasting and substantial. Like calcitonin, the bisphosphonates have been studied for bony tumor and cancer-related pain. There is less evidence addressing their use for OVCF. Given the relative strengths of evidence for calcitonin and the bisphosphonates, and the drugs' safety and side effect profiles, the authors recommend reserving pamidronate for situations where other approaches fail or are contraindicated.
There are few rigorously conducted clinical trials assessing specific therapy for non-septic bursitis. First-line treatments of non-septic bursitis include NSAIDs, aspiration, and injection therapy with corticosteroids and local anesthetics. Patients receiving oxaprozin showed improved overall function scores on a variety of measures. Results for periarticular inflammation other than bursitis are similar to the findings for bursitis. For patients with shoulder bursitis, oral corticosteroids provide early improvement over placebo, but treatment benefit is lost after the first few weeks of therapy. Many corticosteroids have demonstrated effectiveness for injection of subacromial inflammation. For trochanteric bursitis, studies investigating intrabursal injection of corticosteroids have found efficacy similar to that reported for other bursal injection sites. One long-recognized medication-related etiology of subacromial inflammation is the use of protease inhibitors: indinavir and lamivudine. Given the obvious risks in altering these medication regimens, the ED provider should reduce dosages only after consultation with patients' physicians.