Osteoporosis and low bone mass affects >50% of people over 50 years of age or over 50 million people in the United States. Its primary impact, bone fractures also called fragility or low-trauma fractures can occur during normal activities such as bending, coughing, lifting or fall from a standing height. Of the osteoporosis fractures that occur, vertebral compression fractures account for 25% of them. They usually occur at vertebral levels T7-8 and T12-L1. They may cause significant acute and chronic pain, leading to complications of impaired mobility such as pneumonia, loss of bone and muscle mass, incidental falls, blood clots, depression and isolation. Undertreatment my exacerbate morbidity and mortality. Stabilizing these fractures leads to significant mortality and morbidity benefit over nonsurgical treatments.
Causes of Osteoporosis Spine Fractures (Compression Fractures)
Most cases of osteoporosis are age related because aging is accompanied by reduced levels of estrogen and testosterone hormones which at normal levels help insure good bone health. Secondary sources of osteoporosis are numerous and can include adverse effects of drug therapy, endocrine disorders, eating disorders, immobilization, bone marrow-related disorders, disorders of the gastrointestinal or biliary tract, kidney disease, and cancer.
Symptoms of Osteoporosis Spine Fractures (Compression Fractures)
The hallmark symptom of a vertebral compression fracture is back pain which is intense enough to severely limit mobility and activities of daily living. Unfortunately, this symptom can be cause by many other things than a fracture. There are some traits of the pain that do help determine if a fracture might be present such as pain that improves with rest or no movement, history of minimal/low-velocity trauma, pain that increases with movement, acute onset or sudden change in baseline back pain, inability to lie flat because of pain, worsening pain since onset, and intractable pain that is unbearable without prescription pain relieving medication. Severe fractures can cause spinal cord injuries with neurological symptoms such as weakness in legs, sciatica, loss of sensation in legs, and loss of bladder control.
Diagnosis of Osteoporosis Compression Fractures
With new onset of back pain x-ray of the back is often done which can identify compression fractures but cannot determine whether the fracture is old or new. MRI scanning is best an determining the age of the compression fracture with CT scans and bone scans as back up techniques if MRI cannot be done. The age of the fracture is important to determine because repair of new fractures is possible whereas repair of old fractures is not beneficial. There are many insurance company rules regarding repair of only age appropriate fractures so that benefit is obtained in a cost-effective fashion. Other sources of the back pain should also be eliminated before repair is considered and current imaging by MRI can be very useful to determine this.
Treatment of Vertebral Compression Fractures
When certain criteria are met, repair by stabilization of the vertebral compression fracture with cement injection in the fracture site can be beneficial in reducing pain and returning patients to their normal routines. This is done in the office or outpatient surgery area by placing a needle into the fractured vertebral body under x-ray control, inflating a balloon to open the cavity, and then injection of specialized cement that will harden and stabilized the bone via an internal cement cast that is permanent; this procedure is called kyphoplasty. Sedation for the procedure is provided by an anesthetist for patient comfort as lying down for prolonged periods can be uncomfortable. Post-operatively, the patient is treated with medications to reduce the risk of fracture recurrence; this can be done by the PCI team, primary care providers or endocrinology specialists. PCI providers have relieved many patients’ fracture pain with this procedure in the convenient setting of the office fluoroscopy suite.