The best course of treatment and its timing for vertebral fractures remains unknown. Many doctors advise a course of nonoperative treatment first. Pain medications, back braces, bed rest, and exercise are given a good try before using surgery.

The trade off is the strength, function, and motion lost with rest and inactivity. This puts the patient at increased risk for weakness, balance problems, and falls. Side effects from long-term use of medications can also be a problem.

How late is too late for vertebroplasty is an area of ongoing research. Vertebroplasty is the injection of glue into the fractured bone. The goal is to reduce pain while increasing the strength and stiffness of the spine.

In a recent study on this topic, patients with osteoporosis and malignancy were treated with vertebroplasty. The group with osteoporosis had preoperative symptoms for as long as 30 months. The group with cancer had pain for less than four months.

Both groups had good results with vertebroplasty though the malignancy group had more leakage of the cement compared with the osteoporotic group.