Osteoporotic Vertebral Compression Fractures: A Brief Overview
01 May 2018
Osteoporosis is characterized by weakened bones that are more prone to fractures. After its onset, signs and symptoms are not visible for several years until a bone breaks. These fractures mostly occur in the spine (vertebrae), and are termed vertebral compression fractures (VCFs) and result in compression of the bone in the spine leading to its collapse causing severe pain, deformity and height loss. The most common part of the spine affected by VCFs is the lower part of the thoracic spine.
The clinical symptoms of VCFs include sudden back pain, increased intensity of pain while standing or walking, limited mobility of spine, eventual height loss, deformity and disability.
VCFs can lead to complications like segmental instability, kyphosis (hunching of the back) and neurological complications.
The matter of concern- VCFs
More than 700,000 new cases of VCFs are reported in the United States annually with about 100,000 hospital admissions; affecting 25% of all postmenopausal women. It is estimated to cost about $1.5 billion annually. VCFs may increase the risk of future fractures. Osteoporotic fractures often result in cumulative irreversible damage leading to disability and reduced quality of life. For example, in patients with a thoracic or lumbar compression fracture, lung function is reduced significantly in patients.
Diagnosing an Osteoporosis Fracture
It is difficult to diagnose VCF, as it can be identified only after few symptoms are noticed. In cases of osteoporotic hip or wrist fracture, the fractured bone can be easily identified by the standard x-ray. However, in VCFs, sometimes, it may be missed by an x-ray, and the cause of pain may be thought to be just general muscle strain or just back pain, spinal arthritis, or a normal part of the aches and pains associated with aging. This may be one of the reasons for about only one-third of VCFs occurring in US diagnosed annually. CT and MRI scans can be used to confirm VCFs. Bone Density Testing is recommended with a Dual-Energy X-ray Absorptiometry (DEXA) scan to determine the extent of bone loss.
Treatment and medications
The treatment regimen should be decided on the basis of pain and percentage of vertebral collapse. Patients with osteoporotic VCFs are usually treated nonoperatively.
Conservative management is the first-line treatment for painful vertebral compression fractures. Patients can get symptomatic relief by heat, massage, analgesic medications, and bed rest.
Current FRAX guidelines for osteoporosis treatment recommend pharmacological treatment for VCF because of the increased risk of future fractures.
Anti-osteoporotic medications, including bisphosphonates and other anti-resorptive agents, calcium, vitamin D3 supplement and anabolic treatment teriparatide can be used to treat such VCFs. In fact all these treatments increase bone mineral density (BMD).
Vertebroplasty or vertebral augmentation procedure is performed for fracture stabilization and to decrease pain. This procedure can greatly reduce pain with many patients experiencing nearly 90% pain reduction within 1 to 2 days.
Surgical Intervention- kyphoplasty
It can be performed for those patients with compression fractures that do not compromise the spinal canal. The use of a percutaneous balloon expands the fractured vertebrae. The void created by the balloon is then filled with bone cement.
VCFs are a major health problem especially in the elderly population and more so osteoporotic VCF in postmenopausal women resulting in considerable morbidity. BMD testing can be advised in the prone population to prevent osteoporotic VCFs. Weight-bearing exercise and a diet rich in calcium and vitamin D can strengthen the bones and prevent osteoporosis.