Should You Use Orthotic Braces for Vertebral Fractures?

I have been getting a lot of questions from physical therapists and physiotherapists on using orthotic braces to treat clients with osteoporotic fractures. This is an important area in the treatment of clients with osteoporosis and, in particular, those who have had osteoporotic fractures.  

Some of the question that I have been asked include:

• Should we prescribe an orthotic brace to treat a kyphotic client with vertebral fractures?
• Who are the manufacturers and how can I contact them?
• Should the client use a custom solution or are there “off the shelf” products that meet most client needs?

I discussed these questions with Dr. Eugene Wai, a spinal Surgeon at the Ottawa Civic Hospital.  He recommends bracing for less than 10% of patients he sees with compression fractures.

I also met with Mr. Christopher Kraft, Certified Prosthetist and Orthotist and owner of Ampos Othopaedics Inc. in Ottawa to get his opinion.

Relying on the Orthotic Brace

Mr. Kraft sees a brace as exactly that: a brace!  Chris started our conversation by stating that braces “rarely assist in making individuals stronger and that most individuals get weaker with them.”  In other words, a brace is frequently used as a passive intervention that people tend to rely on.

Unless accompanied by education and active intervention (such as strength training), it could become an impediment to independence.  The therapist needs to stay involved with the client and ensure that he or she does not become reliant on the orthotic device.

Summary of Brace Options

Here is a brief summary of the various brace options available to you.  They are categorized by client condition.

Individuals with acute vertebral fractures and minimal kyphosis

For individuals with acute vertebral fractures and minimal kyphosis, a rigid brace is appropriate.  Two models that meet this requirement are:

• Truform Rigid Spinal Orthosis
• C.A.S.H. (Cruciform Anterior Spinal Hyperextension)

Both are available through SPS in the US. Their telephone number 1-800-767-7776 and they will gladly provide you with a Canadian or US distributor near you.   If you prefer, you can set up an account with them directly. Account setup will take about ten days.

Individuals with acute vertebral fractures and more pronounced kyphosis

For individuals with acute vertebral fractures and more pronounced kyphosis, a semi-rigid support is appropriate.  The choices include:

• Camp XXI Thoracolumbar Support
• Fast-Wrap Thoracolumbar Support
• Spinomed III

Distribution in Canada is very poor but you can order directly through: DME Direct. Neither of the braces above is covered by the Canadian Assistive Device Program (ADP).   I was told that Spinomed was covered by the province of Alberta, but that turns out not to be the case.

The price range for the above braces is $90 to $200.  They are much cheaper if you order directly. The Spinomed cost is about $400.

Individuals with minimal kyphosis who require postural correction

For individuals with minimal kyphosis who require postural correction, a useful brace is the DOSI EQ Posture Support by Otto Pack.  You can contact them at 1 800 665 3327

Individuals with more pronounced kyphosis and would benefit from counter weighting

The orthosis for individuals with more pronounced kyphosis and would benefit from counter weighting is the Weighted PTS Posture Support available at DME Direct

Working with an Orthotist

If you are fortunate enough to live near an orthotist, I would encourage you to seek them out and work with them directly – they have a wealth of experience and will be able to measure your client up for best fitting.

Many of the orthotic professional associations have online directories of orthotists by region.  Here is a quick summary of directories by major jurisdiction:

Canadian Association for Prosthetics and Orthotics (CAPO)

To find an orthotist near you:

• Click on “Patients” on Home page
• Click on “Find a CAPO Member Near You”
• At the bottom of the page, you will find the link for the directory.  Click that.
• A new pop-up window is presented to you allowing you to filter by Province and then by City.

American Academy of Orthotists and Prosthetists

This Association has a Member Directory but I found it near impossible to use.  I suggest you Google the word “orthotist” with the name of your city.

Alternatively, you can also use the online License Verification function available at most State level Health Department web sites.

Feedback and Comments—Please!

Should you have any comments or questions on this article or would like to add things that you have found, please contact me directly.

Update on the Spinomed

Many Canadian based therapists have found it challenging to get access to the Spinomed.

Study findings on the Spinomed (presented in the MelioGuide Level I Workshop) were done when it was a heat molded brace.  It is now a cold molded brace.  Mr. Kraft believes as a cold molded brace that it would not provide enough support.

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