Zain Nassrullah, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Germain Sophie Ngana MD, PhD, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Markian Pahuta MD, PhD, FRCSC, Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Mohammad Zarrabian MD, FRCSC, Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Daipayan Guha MD, PhD, FRCSC, Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.

Abstract
Osteoporosis and vertebral compression fractures are commonly encountered pathologies that can have a significant impact on mobility, quality of life, and overall morbidity. Here we review the diagnosis, epidemiology, and risk factors of osteoporosis, as well as the most recent recommendations for primary and secondary prevention. Additionally, the current treatment approaches of vertebral compression fractures are discussed, including the roles of non-operative and operative management, indications for surgical intervention, and the evidence available to support treatment decisions.
Key Words: osteoporosis, VCF, vertebroplasty, kyphoplasty.

INTRODUCTION
Osteoporosis has a very high disease burden with a prevalence of 11.9% in Canadians 40 years or older, amounting to 1.8 million women and 400,000 men, with the total prevalence increasing to 31% in those aged 80 to 84 years old.¹ Consequently, vertebral compression fractures (VCFs), one of the most common complications of osteoporosis, have an annual incidence of 10.7 per 1000 women and 5.7 per 1000 men in the United States, with a lifetime prevalence of 25% in postmenopausal women.²

VCFs are associated with chronic pain, impaired mobility, and kyphosis, leading to a reduced quality of life and increased risk of mortality.³ As such, an understanding of the risk factors of osteoporosis, primary and secondary prevention of VCFs, as well as appropriate treatment modalities is essential given the societal and healthcare impacts of osteoporosis and VCFs.

Overview of Osteoporosis
The World Health Organization (WHO) defines osteoporosis as a bone mineral density (BMD) level below 2.5 standard deviations of the young adult reference mean.⁴ Alternatively, low-level trauma leading to a fracture associated with osteoporosis (i.e., hip, vertebral, humerus, pelvis) in individuals 50 years or older, or a fracture risk of at least 20% using the Fracture Risk Assessment Tool (FRAX) can be used to establish an osteoporosis diagnosis clinically.5 FRAX calculates the ten-year probability of fractures using a combination of demographic information (age, sex, weight, height), BMD, and risk factors associated with osteoporosis (Table 1).⁵ Etiologies of secondary osteoporosis commonly include endocrine disorders of the thyroid and parathyroid glands, malabsorption syndromes, and systemic glucocorticoid therapy (Table 2).⁴