OSTEOPOROSIS AND SPINAL COMPRESSION FRACTURE
Overview
Osteoporosis is characterized by a decrease in bone density, and weakening the bone. The bone becomes brittle and fragile. The outer supportive cortes and spongy tissue in the bone becomes thinner. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. It increases susceptibility to fracture. It can be so brittle that a fall, bending over or coughing may cause a fracture.
Bone density decreases after 35 years of age, and bone loss occurs more rapidly in women after menopause.
An estimated 10 million Americans have osteoporosis, 8 million women and 2 million men. Vertebral compression fractures (VCFs) are the most common fracture in patients with osteoporosis, affecting about 750,000 people annually. People who have sustained one osteoporotic VCF are at five times the risk of sustaining a second VCF.
Osteoporosis with normal bone density on the top and low density on the bottom.
Symptoms and Signs
Osteoporosis does not have any symptoms. It is not painful and it does not interfere patient’s function. It is called silent disease or silent killer.
The symptoms started when patients have fracture. Vertebral compression fracture or spinal fracture is the most common fractures.
Pain:
The common symptom of fracture is pain. Typical findings may include the following:
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The pain may start suddenly with a fall, or bending forward or cough
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The pain may localize in the mid-back if the fracture in thoracic spine, or low back if the fracture in lumbar spine. The pain may radiate to abdomen or legs.
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The pain can be dull, aching, sharp. Any moverment of the back may exacerbate the pain, and keeping back still, such as lying in bed still alleviates the pain.
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The pain may be associated with paravertebral muscle spasms.
Loss of height:
Loss of height can be due to collapse of the vertebrae.
Kyphosis:
Progressive curvature of spine ("dowager hump" or Kyphosis) may occur.
Functional Restriction:
Functional Restriction may occur if it is severe enough. "Dowager hump" with Pain, stiffness, inflexible may compress lungs and stomach, and restrict functioning of respiration and digestion, and more.
Risk factors for osteoporosis
Osteoporosis with normal bone density on the left and low density on the right.
Vertebral compression fracture. People with osteoporosis are high risk of fracture.
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Female
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Advanced age
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Thin body habitus, small frame
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Caucasian or Asian
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Smoker
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Estrogen deficiency, such as menopause or ovaries removal
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Vitamin D deficiency
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Family history of osteoporosis
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Certain medications such as steroids
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Low testosterone levels in men
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Excessive alcohol intake
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Inactive lifestyle
Prevention and Treatment of Osteoporosis
The prevention and treatment of osteoporosis is to prevent bone fractures due to bone loss. The osteoporosis treatment and prevention has several steps as follows:
Lifestyle changes:
Exercise:
Weight-bearing exercise is recommended, such as walking.
Smoking:
Smoking cigarettes can lead to bone loss in women before menopause and postmenopausal women.
Alcohol:
Alcohol can be another risk factor to cause osteoporosis.
Caffeine:
Caffeine can also contribute to bone loss and lead to osteoporosis.
Diet:
Diet with calcium and vitamin D may promote calcium absorbtion and prevent calcium loss.
Medications:
Medications may stop bone loss and increase bone strength, and increase bone formation.
The figure shows vertebral compression fractures with wedge shape in a real bone.
X-Ray picture shows vertebral compression fracture, which is wedge shape.
Treatment of Spinal Compression Fracture
Spinal compression fracture is very painful and commonly caused by osteoporosis. Therefore, the treatment should focus on the pain, the fracture, and prevention and treatment of osteoporosis.
1. Conservative Treatment for Spinal Compression Fractures
Initial treatment for spinal compression fracture is Pain management.
Pain medications:
Over-the-counter pain medications, such as Acetaminophen and non-steroidal anti-inflammatory drugs, such as Ibuprofen are enough if the pain is not so severe.
Opioid pain medications can be used for short term if the pain is severe and can not be controlled on over-the-counter pain medications.
Antineurolytic agents and Antidepressants may also help if the patient has neurogenic pain.
Bed Rest:
Bed rest for acute phase can help to relieve the pain. However, it is only recommended for a short period of time. Prolonged best rest may encourage further bone loss and function deterioration. Bed rest also raises the risk for future compression fractures.
Back Immobilization:
A back brace can immobilize the movement of fracture spine to reduce pain, and to promote healing.
2. Osteoporosis Prevention and treatment
The patient is highest risk of further compression fracture if the patient has a history of fracture. Osteoporosis Prevention and treatment should be part of the fracture treatment because prevention of more spinal fracture is important.
3. Interventional Pain Management
Two types of interventional pain management procedures, kyphoplasty or vertebroplasty are treatment choices if the patient does not respond to conservative pain management. They are minimally invasive pain management procedure. They are designed to help eliminate or reduce pain and stabilize the fractured vertebra. During the procedure, a special needle is inserted into the fractured vertebra. Cement mixture is then injected into the vertebra. The patient may go home after the procedure at the same day. Kyphoplasty is different from vertebroplasty. Kyphoplasty is to inflate a balloon to restore some or all of the lost vertebral body height. Then cement is injected to stabilize the fractured vertebra. Vertebroplasty is to inject cement into the fractured vertebra without inflating the vertebra with a balloon or restoring the height of vertebra.
4. Surgical Treatment
Spinal fusion can be the choice if the patient has intractable pain and does not respond to conservative and interventional pain management. Surgeon may use rods and screws to stabilized the fractured vertebra. The pain can be resolved or reduced when the fractured vertebra does not move
Progressive curvature of spine (dowager hump or kyphosis) due to compression fracture