Review article| Volume 97, ISSUE 6, P1013-1025, June 2016

Spinal Orthoses for Vertebral Osteoporosis and Osteoporotic Vertebral Fracture: A Systematic Review

  • Meredith Newman
    Corresponding author Meredith Newman, MSc, Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7HE, England.
    Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England

    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
    Search for articles by this author
  • Catherine Minns Lowe
    Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England
    Search for articles by this author
  • Karen Barker
    Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England

    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
    Search for articles by this author
Published:November 23, 2015DOI:



      To systematically review the evidence of effectiveness of spinal orthoses for adults with vertebral osteoporosis.

      Data Sources

      We conducted a systematic literature search using the databases of PubMed, MEDLINE, EMBASE, AMED, CINAHL, PEDro, and the Cochrane Library from January 1995 to October 2014.

      Study Selection

      Two reviewers evaluated eligibility. Randomized controlled trials (RCTs), pilot RCTs, and prospective nonrandomized controlled studies of spinal orthoses for people with vertebral osteoporosis or osteopenia with and without osteoporotic vertebral fracture (OVF) that examined outcomes related to fracture consolidation, pain, strength, posture, balance, physical function, quality of life, and complications were eligible.

      Data Extraction

      Two reviewers independently extracted data and evaluated methodological quality using a domain-based risk-of-bias approach.

      Data Synthesis

      Twelve studies were included: 8 RCTs or pilot RCTs and 4 nonrandomized studies involving 626 participants. Three studies (n=153) evaluated orthoses after acute OVF; none were of high quality. Complications were highest with rigid orthoses. Evidence that orthoses could affect vertebral deformity was lacking. Nine studies (n=473) of varying quality considered orthoses in subacute and longer rehabilitation. Three suggested a semirigid backpack thoracolumbar orthosis (TLO) could benefit strength, pain, posture, and quality of life. One found a weighted kypho-orthosis (WKO) improved balance.


      The limited evidence about orthoses after acute OVF is inconclusive; better evidence of efficacy is needed, particularly when considering complications. The promising evidence regarding the backpack TLO and WKO needs to be explored further in studies of sufficient size and quality that include men.


      List of abbreviations:

      OVF (osteoporotic vertebral fracture), RCT (randomized controlled trial), TLO (thoracolumbar orthosis), TLSO (thoracolumbosacral orthosis), WKO (weighted kypho-orthosis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • International Osteoporosis Federation
        Data and publications: facts and statistics.
        (Available at:) (Accessed August 3, 2015)
        • Prather H.
        • Hunt D.
        • Watson J.
        • Gilula L.A.
        Conservative care for patients with osteoporotic vertebral compression fractures.
        Phys Med Rehabil Clin N Am. 2007; 18: 577-591
        • Miyakoshi N.
        • Itoi E.
        • Kobayashi M.
        • Kodama H.
        Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis.
        Osteoporos Int. 2003; 14: 1007-1012
        • Sinaki M.
        • Brey R.
        • Hughes C.
        • Larson D.
        • Kaufman K.
        Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a spinal proprioceptive extension exercise dynamic (SPEED) program.
        Mayo Clinic Proc. 2005; 80: 849-855
        • Azadinia F.
        • Kamyab M.
        • Behtash H.
        • Maroufi N.
        • Larijani B.
        The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis.
        Prosthet Orthot Int. 2013; 37: 404-410
        • Kado D.M.
        The rehabilitation of hyperkyphotic posture in the elderly.
        Eur J Phys Rehabil Med. 2009; 45: 583-593
        • Longo U.M.
        • Loppini M.
        • Denaro L.
        • Maffulli N.
        • Denaro V.
        Osteoporotic vertebral fractures: current concepts of conservative care.
        Br Med Bull. 2012; 102: 171-189
        • Esses S.I.
        • McGuire R.
        • Jenkins J.
        • et al.
        American Academy of Orthopaedic Surgeons clinical practice guideline on: the treatment of osteoporotic spinal compression fractures.
        J Bone Joint Surg Am. 2011; 93: 1934-1936
        • Valentin G.H.
        • Pedersen L.N.
        • Maribo T.
        Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures.
        Prosthet Orthot Int. 2014; 38: 232-238
        • Hazzard M.A.
        • Huang K.T.
        • Toche U.N.
        • et al.
        Comparison of verteroplasty, kyphoplasty, and nonsurgical management of vertebral compression fractures and impact on US healthcare resource utilisation.
        Asian Spine J. 2014; 8: 605-614
        • Chang V.
        • Holly L.T.
        Bracing for thoracolumbar fractures.
        Neurosurg Focus. 2014; 37: E3
        • Agabegi S.S.
        • Asghar F.A.
        • Herkowitz H.N.
        Spinal orthoses.
        J Am Acad Orthop Surg. 2010; 18: 657-667
        • Bonaiuti D.
        • Arioli G.
        • Diana G.
        • et al.
        SIMFER Rehabilitation treatment guidelines in postmenopausal and senile osteoporosis.
        Eura Medicophys. 2005; 41: 315-337
        • Pfeifer M.
        • Sinaki M.
        • Guesens P.
        • et al.
        Musculoskeletal rehabilitation of osteoporosis: a review.
        J Bone Miner Res. 2004; 19: 1208-1214
        • Kaplan R.S.
        • Sinaki M.
        • Hameister M.D.
        Effect of back supports on back strength in patients with osteoporosis: a pilot study.
        Mayo Clin Proc. 1996; 71: 235-241
        • Pfeifer M.
        • Begerow B.
        • Minne H.W.
        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
        • Meade K.P.
        • Malas B.S.
        • Patwardhan A.
        • Gavin T.
        Orthoses for osteoporosis.
        in: Hsu J.D. Michael J.W. Fisk J.R. AAOS atlas of orthoses and assistive devices. 4th ed. Mosby, Philadelphia2008: 155-166
        • Ohana N.
        • Sheinis D.
        • Rath E.
        • Sasson A.
        • Atar D.
        Is there a need for lumbar orthosis in mild compression fractures of the thoracolumbar spine?: A retrospective study comparing the radiographic results between early ambulation with and without lumbar orthosis.
        J Spinal Disord. 2000; 13: 305-308
        • 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
        • Bornemann R.
        • Hanna M.
        • Kabir K.
        • Goost H.
        • Wirtz D.C.
        • Pflugmacher R.
        Continuing conservative care versus crossover to radiofrequency kyphoplasty: a comparative effectiveness study on the treatment of vertebral fractures.
        Eur Spine J. 2012; 21: 930-936
        • Meccariello L.
        • Cervelli C.
        • Muzii V.F.
        • Mugnaini M.
        • Ferrata P.
        Dynamic orthosis versus three-point orthosis in treating osteoporosis fractures in the elderly: a perspective study.
        Eur Spine J. 2013; 22: 900-952
        • Li M.
        • Law S.-W.
        • Cheng J.
        • Kee H.-M.
        • Wong M.S.
        A comparison study on the efficacy of SpinoMed and soft lumbar orthosis for osteoporotic vertebral fracture.
        Prosthet Orthot Int. 2015; 39: 270-276
        • Dionyssiotis Y.
        • Trovas G.
        • Thoma S.
        • Lyritis G.
        • Papaioannou N.
        Prospective study of spinal orthoses in women.
        Prosthet Orthot Int. 2015; 39: 487-495
        • Vogt L.
        • Hildebrandt H.D.
        • Brettmann K.
        • Fischer M.
        • Banzer W.
        Clinical multidimensional evaluation of a multifunctional osteoporosis-orthosis.
        Phys Med Rehab Kuror. 2005; 15: 1-8
        • Pfeifer M.
        • Kohlwey L.
        • Begerow B.
        • Minne H.W.
        Effects of two newly developed spinal orthoses on trunk muscle strength, posture, and quality-of-life in women with postmenopausal osteoporosis: a randomized controlled trial.
        Am J Phys Med Rehabil. 2011; 90: 805-815
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions; explanation and elaboration.
        BMJ. 2009; 339: b2700
      1. Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions. Cochrane Book Series. Wiley-Blackwell, West Sussex2008
        • Tonbul M.
        • Yilmaz M.R.
        • Ozbaydar M.U.
        • Adas M.
        • Altan E.
        Long-term results of conservative treatment for thoracolumbar compression fractures.
        Acta Orthop Traumatol Turc. 2008; 42: 80-83
        • Murata K.
        • Watanabe G.
        • Kawaguchi S.
        • et al.
        Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support.
        J Neurosurg Spine. 2012; 17: 469-475
        • Wood K.
        • Butterman G.
        • Mehbod A.
        • Garvey T.
        • Jhanjee R.
        • Sechriest V.
        Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study.
        J Bone Joint Surg Am. 2003; 85: 773-781
        • Tezer M.
        • Erturer R.E.
        • Ozturk C.
        • Ozturk I.
        • Kuzgun U.
        Conservative treatment of fractures of the thoracolumbar spine.
        Int Orthop. 2005; 29: 78-82
        • Stadhouder A.
        • Buskens E.
        • Vergroesen D.A.
        • et al.
        Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options.
        J Orthop Trauma. 2009; 23: 588-594
        • Liaw M.-Y.
        • Chen C.L.
        • Chen J.F.
        • Tang F.T.
        • Wong A.M.
        • Ho H.H.
        Effects of Knight-Taylor brace on balance performance in osteoporotic patients with vertebral compression fracture.
        J Back Musculoskeletal Rehabil. 2009; 22: 75-81
        • Muller I.
        • Bayer M.
        [Rehabilitation and prosthetic care of osteoporotic fractures at thoracolumbar spine] [Czech].
        EuroRehab. 1999; 3-4: 465-468
        • Rohlmann A.
        • Zander T.
        • Graichen F.
        • Bergmann G.
        Effect of an orthosis on the loads acting on a vertebral body replacement.
        Clin Biomech (Bristol, Avon). 2013; 28: 490-494
        • Kishikawa Y.
        Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures.
        Int J Gen Med. 2012; 5: 373-380
        • Tanaka K.
        • Akune T.
        • Shimoi Y.
        • Kakurai S.
        • Akai M.
        • Tobimatsu H.
        An investigation for the effect of spinal orthosis (so called Rucksack type orthosis) for kyphosis with osteoporotic thoraco-lumbar vertebral fracture.
        Jpn Assoc Rehabil Med. 2000; 37: 106-109
        • Ishida H.
        • Watanabe S.
        • Yanagawa H.
        • Kawasaki M.
        • Kobayashi Y.
        • Amano Y.
        Immediate effects of a rucksack type orthosis on the elderly with decreased lumbar lordosis during standing and walking.
        Electromyogr Clin Neurophysiol. 2008; 48: 53-61
        • Watanabe H.
        • Kutsuna T.
        • Asami T.
        • Inoue E.
        New concept of spinal orthosis for weakened back muscles.
        Prosth Orthot Int. 1995; 19: 56-58
        • Fink M.
        • Kalpakcioglu B.
        • Karst M.
        • Bernateck M.
        Efficacy of a flexible orthotic device in patients with osteoporosis on pain and activity of daily living.
        J Rehabil Med. 2007; 39: 77-81
        • Vogt L.
        • Hübscher M.
        • Brettmann K.
        • Banzer W.
        • Fink M.
        Postural correction by osteoporosis orthosis (Osteo-med): a randomized, placebo-controlled trial.
        Prosthet Orthot Int. 2008; 32: 103-110
        • Hildebrandt H.-G.
        • Vogt L.
        [The osteoporosis body - a multifunctional orthosis] [German].
        Orthopadie Technik. 2002; 53: 90-96
        • Matussek J.
        • Boluki D.
        • Fussel S.
        • Grifka J.
        [Orthotic methods for osteoporosis and osteoporotic vertebral fracture] [German].
        Orthopade. 2010; 39: 387-396
        • Peters A.
        • Friebe H.
        Prevention of vertebral and hip fractures in elderly patients with osteoporosis with use of spinal orthoses and hip protectors.
        Orthopadietechnik in der Akt Rheumatol. 2005; 31: 212-216
        • Nagel-Albustin K.
        • Preisinger E.
        [Proprioceptive orthoses in osteoporosis] [German].
        J Miner Stoffwechs. 2012; 19: 120-123
        • Chiba K.
        • Munehito Y.
        • Kenichi S.
        • Kazuhiko S.
        • Kensei N.
        Conservative managements for osteoporotic thoracolumbar vertebral compression fractures: a multicentre prospective RCT.
        Spine. 2011; 36: S1-S171
        • Hübscher M.
        • Schmidt K.
        • Fink M.
        • Vogt L.
        • Banzer W.
        [Prospective evaluation of the effects of a spinal orthosis on physical function and quality of life in women with osteoporosis] [German].
        Z Orthop Unfall. 2010; 148: 443-447
        • Schmidt K.
        • Hübscher M.
        • Vogt L.
        • et al.
        Influence of spinal orthosis on gait and physical functioning in women with postmenopausal osteoporosis [German and English].
        Orthopade. 2012; 41: 200-205
        • Dionyssiotis Y.
        Management of osteoporotic vertebral fractures.
        Int J Geriatr Med. 2010; 3: 167-171
        • Talic A.
        • Kapetanovic J.
        • Dizdar A.
        Effects of conservative treatment for osteoporotic thoracolumbal spine fractures.
        Mater Sociomed. 2012; 24: 16-20
        • Gündoğdu M.
        • Öncel S.
        • Şahin E.
        • Baydar M.
        • Dilek B.
        [The effect of posture support corset on balance, quality of life, dorsal kyphosis in patients with kyphosis due to osteoporosis] [Turkish].
        Turk J Geriatr. 2013; 16: 235-259
        • Sinaki M.
        • Lynn S.G.
        Reducing the risk of falls through proprioceptive dynamic posture training in osteoporotic women with kyphotic posturing: a randomized pilot study.
        Am J Phys Med Rehabil. 2002; 81: 241-246
        • Raeissadat S.A.
        • Sedighipour L.
        • Pournajaf S.
        • Kashani R.V.
        • Sadeghi S.
        Effect of posture training with weighted kypho-orthosis (WKO) on improving balance in women in osteoporosis.
        J Aging Res. 2014; 2014: 427903
        • Giele B.M.
        • Wiertsema S.H.
        • Beelen A.
        • et al.
        No evidence for the effectiveness of bracing in patients with thoracolumbar fractures: a systematic review.
        Acta Orthop. 2009; 80: 226-232
        • Tsujio T.
        • Nakamura H.
        • Terai H.
        • et al.
        Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for non-union: a prospective multicentre study.
        Spine (Phila Pa 1976). 2011; 36: 1229-1235
        • Alcala-Cerra G.
        • Paternina-Caicedo A.J.
        • diaz-Becerra C.
        • Moscote-Salazar L.R.
        • Fernandes-joaquim A.
        Orthosis for thoracolumbar burst fractures without neurologic deficit: a systematic review of prospective randomized controlled trials.
        J Craniovertebr Junction Spine. 2014; 5: 25-32