Roughly 50 million Americans have osteoporosis or have an increased risk of developing osteoporosis. Osteoporosis is a state of diminished bone density and bone quality. It leads to porous or soft bone and places patients at high risk for fragility fractures of the hip, wrist and spinal vertebra. Fragility fractures occur from minor trauma, such as falling from a standing position.
Vertebral compression fractures are the most common type of fragility fracture and can even occur with non-traumatic events, such as sneezing or coughing. Long bones, such as those found in the leg or arm, break like a tree branch when broken – whereas, vertebra “compress” like a crushed aluminum can when fractured. Compression fractures involve collapse of the vertebral body when forces placed upon it exceed its strength. Osteoporosis is a common factor in compression fractures because it causes the vertebra to be less strong.
In addition to osteoporosis, other metabolic disorders such as thyroid, kidney, and rheumatological diseases or tumors can weaken bone and lead to compression fractures as well.
Compression fractures may occur without symptoms. When symptomatic, pain usually occurs at the location of the fracture. The pain is often aggravated by standing upright or changing positions and relieved by lying down. A hunchback deformity, known as kyphosis, may develop – especially when multiple levels are involved. This may, in turn, cause difficulty breathing and impair nutrition. In rare cases, compression fractures can lead to nerve damage or spinal cord injury. Most fracture pain will heal with time, however, approximately a quarter to a third of patients will develop prolonged pain.
Patients that experience sudden onset of severe pain in the spine (with/without trauma) should seek medical attention. X-rays may reveal the site of fracture. Advanced imaging such as MRI or bone scan can help to identify early fractures and to determine if the fracture is old or new. Generally speaking, MRI is the best study to determine if the fracture occurred recently.
Conservative treatments may include rest, activity modifications, NSAIDs, pain medications, nasal calcitonin, and back bracing. Some patients, who report immediate incapacitating pain or develop prolonged debilitating pain despite an adequate trial of non-operative treatment (3-6 weeks), may benefit from surgical intervention such as Vertebroplasty or Kyphoplasty.
Vertebroplasty involves injecting liquid cement under high pressure into fractured vertebra. The liquid cement polymerizes and hardens once inside the bone. Kyphoplasty involves placing a balloon percutaneously inside the collapsed vertebra to create a cavity and restore the height of the collapsed vertebra. The balloon is then deflated, withdrawn and liquid cement is placed under low pressure.
Studies show both Vertebroplasty and Kyphoplasty display greater pain relief, functional recovery, and improved quality of life over non-operative treatment. Kyphoplasty has the theoretical advantage of partially restoring vertebral body height.
Whether patients with osteoporotic vertebral compression fractures are treated conservatively versus operatively, the most important goal of management is to treat the underlying osteoporosis. Up to 50% of patients with a previous osteoporotic fragility fracture will sustain an additional fragility fracture. Bone density testing (DEXA scan) is used to assess bone density, which can help guide treatment.
Current recommendations from the American Society of Bone and Mineral Research for patients older than 65 years of age with a hip or vertebral fracture is to start bisphonate therapy (anti-resorptive medication). Treatment should not be delayed for bone density testing. Bisphonate therapy is shown to decrease recurrent fragility fracture by almost 75%.
The best treatment for osteoporotic vertebral compression fractures is prevention. Addressing calcium and vitamin D deficiencies, emphasizing the importance of weight bearing exercises, and identifying treatable causes, such as smoking and poor nutrition, can help reduce risk and severity of osteoporosis.
If you would like to learn more about osteoporosis or osteoporotic vertebral compression fractures, McBride has multiple specialists that look forward to visiting with you. We encourage you to make an online appointment or call 405.230.9270.
