Osteoporotic Compression Fractures

OSTEOPOROTIC COMPRESSION FRACTURES

 

As a spine surgeon, it’s important for me to be well versed in all treatment modalities for spinal conditions. One of the most common conditions that I see in my patients is osteoporosis. Osteoporosis literally means porous bone, hence, this is a disease where the quality and density of bone is greatly reduced. When this occurs, the incidence of fractures greatly increases and unfortunately many patients will not know they have the disease until a fracture occurs. The most common type of fracture that I see in my patients is called a compression fracture. Vertebral compression fractures occur when the vertebrae in the spine collapses. This can lead to severe back pain, spinal deformity, and a loss of disc height.

This is an important topic because it is extremely common and several treatment modalities exists. There are 1.5 million osteoporotic related fractures each year and around half of those are vertebral fractures. The mortality rate in one year is doubled following a vertebral fracture and even 25% greater than the mortality from a hip fracture. Once a vertebral fracture has occurred, there is a five times greater chance of having another occur. There are several factors than increase an individual's risk of having an osteoporotic fracture. For instance, it’s most common in females between the age of 40-90. People who are most at risk also have arthritis, previous fractures, use tobacco, and have 3 or more alcoholic drinks per day. On the Brightside, there are many treatment options available including many preventative and non-surgical options.

MEDICAL TREATMENT OPTIONS

First and foremost, it’s vital to promote adequate bone health for prevention. This includes adequate calcium and vitamin D3 intake, avoid controllable risk factors like tobacco and alcohol, and engage in weight-bearing exercises to increase bone density. Medication options are also out there. These include Bisphosphonates which is a common first line of defense to prevent osteoporosis. They are a class of drugs that prevent the loss of bone density. They work by slowing down the cells that break down bone (osteoclasts) which allows bone-building cells (osteoblasts) to work more efficiently to strengthen the bone. Other common treatment includes injections, the most common being Prolia. This medication is typically administered via an injection every 6 months and it has a similar mechanism of action; slowing down the osteoclasts which break down bone. Both of these treatment options may have side effects and are not suitable for everyone.

SURGICAL TREATMENT OPTIONS

Once the fracture has occurred, it can worsen in a short period of time. If severe enough, an option to prevent further damage may be surgical stabilization with pedicle screws. There are also multiple outpatient procedure options that have great results and data to support effectiveness.

Vertebroplasty- typically an outpatient procedure where cement is injected directly into the fracture to harden/stabilize.

Kyphoplasty- similar to vertebroplasty, except a balloon-type device is inflated in the vertebral body to create a cavity/internal cast into which a medical-grade acrylic cement is injected under low pressure. Balloon Kyphoplasty has a lot of supporting data showing significant improvement when compared to non-surgical treatment options for compression fractures. The studies also show a reduction in back pain, and opioid usage. Kyphoplasty is typically done with local anesthesia and/or conscious sedation and only takes about 20 minutes per vertebral body and is most commonly performed in an outpatient setting. Most patients experience significant improvement or even a full recovery within 6-12 weeks and can return to a full exercise program shortly thereafter.

Something that I’ve always stood behind is practicing evidence-based medicine. With that being said, the data is now showing that the best first line of defense may be cement augmentations versus non-operative care. Osteoporotic compression fractures are extremely common and can worsen at a rapid pace if the proper protocols are not taken by physicians. 

 

 

Author
Dr. Kenneth Nwosu As a spine surgeon specializing in neck and lower back pain, Kenneth Nwosu, MD, is skilled in the cutting-edge techniques to address chronic pain and mobility issues caused by underlying spinal disease or injury. Dr. Nwosu believes in the many benefits that minimally invasive surgical techniques can offer his patients, including minimal hospitalization and expedient pain relief and return to an active lifestyle. He offers a variety of surgical options at his multidisciplinary spine practices in Burien and Puyallup, Washington.

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