Personal experience in managing acute compression fractures, their aftermath, and the bone pain syndrome, in osteoporosis.

Recovery from acute symptomatic vertebral compression fractures in osteoporosis patients can be said to occur in three broad stages. For over three decades the author managed them in the following way. In the 3-week-long acute stage after the fracture, the patient usually stayed in bed for 4-8 days until able to turn easily from side to side. Then a back support was provided and the patient was allowed up for frequent but brief intervals. In the following approximately 10-week-long healing stage, the patient lay down for 20 min every 2 h (the Intermittent Horizontal Rest Regimen or IHRR). Patients who developed a subsequent lordotic low back pain stage did the IHRR for a further 10 weeks. In the uncommon bone pain syndrome, doing the IHRR for 10 weeks, or occasionally longer, also relieved pain. When the IHRR failed to provide early pain relief in a compliant patient, other causes of the pain were sought and were usually found.