202576 Fractures in older adults associated with chiropractic care or spinal manipulation: Analysis of articles indexed in PubMed

Monday, November 9, 2009: 5:00 PM

Claire Johnson, DC, MSEd , Editor, Professor, National University of Health Sciences, Oceanside, CA
Bart Green, MSEd, DC , National University of Health Sciences, Oceanside, CA
Objective: It is commonly thought that chiropractic care for older adults may result in adverse effects, such as fracture. This study analyzes the literature indexed in PubMed that includes the term “fractures” associated with chiropractic care or spinal manipulation in older adults.

Methods: A PubMed search from 1984 to February 2009 was performed. Search terms were: ‘chiropractic' or ‘spinal manipulation' combined with ‘fracture' and limitations were: ‘humans' and ‘aged: 65+ years.' All languages were included.

Results: The search resulted in 18 articles; 15 were case studies/series. Of the case studies, only 4 (27%) were associated with harm (eg, implication that chiropractic care or spinal manipulation may have caused fracture). The other 11 (73%) had positive implications with chiropractic care. Eight cases reported that the doctor of chiropractic correctly identified and referred the patient or identified a fracture that was previously missed in another healthcare setting. Three of the case reports/series reported positive patient response to chiropractic management of spinal fracture (eg, conservative management of lumbar compression fracture). The 3 other studies included 2 in vitro studies and one chart review. No experimental or prospective studies were identified.

Conclusions: Over the past 25 years, articles reporting fractures in older adults associated with chiropractic care or spinal manipulation are rare, which suggests that chiropractic care may be relatively safe for older adults. The majority of the articles found suggested that chiropractors discover, instead of cause, fractures. Further studies analyzing risk for fracture, safety, and adverse events are needed.

Learning Objectives:
1. Describe current literature that associates fracture in older adults with chiropractic or spinal manipulation 2. Describe risk for fracture in older adults who are receiving chiropractic care or spinal manipulation 3. List future research needed to address risk for fracture and safety issues related to chiropractic care for older adults

Keywords: Chiropractic, Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have met all 3 of the criteria for authorship: 1) substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; 2) drafting the article and revising it critically for important intellectual content; and 3) final approval of the version to be submitted. I am a journal editor and have taught on this subject before. Editor of JMPT, JCM, and JCH Professor, NUHS
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.