Understanding vertebral compression fractures caused by osteoporosis
Michael Connelly, M.D.
At 81, John lives a very active life. This Massachusetts resident works full-time as a CPA and stays active with four grown children, eight grandchildren and seven great-grandchildren. However, in April, while walking to the bathroom one night, John fell.
At first, he simply decided to rest and allow himself to heal. But after a few days, the pain from his back intensified to the point that it became almost unbearable. Yet, even with the debilitating pain, John refused to take medicine and instead chose to tough it out.
“Tylenol did nothing for me and I had no interest in taking prescription painkillers despite the fact that my pain was an eight or nine out of 10 most of the time,” he said.
Eventually, John made his way to his primary care physician, who referred him to me.
X-rays confirmed that John had not only broken two ribs and his clavicle, but also two vertebrae, a condition known as vertebral compression fracture or VCF. The broken vertebrae explained his intense lingering back pain. Whether living alone or in a senior care community, aging puts people at risk for bone mass and density loss. And although a person might be active and eat well, accidents happen and the results can be damaging.
The numbers aren't in our favor
One in three women over age 50 will experience osteoporotic fractures, as will one in five men over 50. According to the Department of Health and Human Services office of the Surgeon General, by 2020, one in two Americans over age 50 will be at risk for fractures from osteoporosis and low bone mass.
According to The Breaking Spine, a benchmark report issued by the International Osteoporosis Foundation, two-thirds of spinal osteoporotic fractures remain undiagnosed and untreated due in part to lack of awareness about osteoporosis and available treatment options. This condition, VCF, is most commonly caused by osteoporosis, but also can result from some forms of cancer. Spinal fractures can occur from something as simple as coughing, sneezing, turning the wrong way, or even bending over to pick up something off the floor.
As we learned from John's case, these fractures can result in serious negative health issues, such as back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression. Vertebral fractures also significantly impact activities of daily living (1, 2).
Traditional treatment for spinal fractures includes bed rest, pain medication, physical therapy, and back bracing. While these therapies may help to decrease a patient's pain over time, they do not address the lost height of the vertebral body related to the osteoporotic fractures. Many patients suffer in pain for too long before seeking treatment, due to a lack of awareness about spinal fractures and alternative treatment options. Approximately 50% of people with a single osteoporotic fracture will have another fracture or a greater than five-fold risk of subsequent vertebral compression fractures (3).
There is now help for patients with VCF, which has been shown in clinical studies to provide pain relief quickly (4). Several recent large clinical studies following patients for at least 12 months after vertebral compression fracture have concluded that mortality rates following VCFs are significantly higher for patients treated conservatively versus surgical treatment.
This minimally invasive procedure is called balloon kyphoplasty, and it's designed to stabilize spinal fractures and attempts to restore the vertebral body's height. During a balloon kyphoplasty, orthopedic balloons are inserted then inflated to create a cavity that is filled with thick bone cement to lift the fractured vertebrae, return them to the correct position. A recent study showed that, compared to non-surgical management, it reduced back pain and improved function and overall quality of life.
In addition to treating vertebral compression fractures due to osteoporosis, the procedure can also be used to treat pathological fractures due to cancer. The procedure stabilizes the fracture, but does not address the underlying problem of osteoporosis.
For healthcare providers, it is important to identify individuals at risk. Bone health is best maintained over a lifetime by attention to key preventative strategies; adequate calcium, adequate vitamin D, weight bearing exercises, and awareness of personal risk (e.g., family history, tobacco use, corticosteroid use, rheumatoid arthritis). People at risk should have their bone mineral density assessed, and treated with antiresorptive or anabolic agents.
John described his 45-minute procedure as, “No big deal. I was aware but felt nothing."
He could not believe the immediate pain relief he felt afterwards.
“I rolled into the hospital in a wheelchair and walked out with a cane the same day. And I did not take any pain medication before or after the procedure. Words can't describe it. I would recommend this procedure to anyone.” Only two weeks after the procedure, John said he was “99 percent back to normal.”
Thanks to balloon kyphoplasty, John can get back to work and his family, doing what he loves.
Important risk information:
Keep in mind that results of this procedure may vary, and all treatment and outcome results are specific to the individual patient. Results may vary. A prescription is required. The complication rate for balloon kyphoplasty has been demonstrated to be low. There are risks associated with the procedure, including serious complications, and though rare, some of which may be fatal. These include, but are not limited to heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood, fat or cement that migrates to the lungs, heart, or brain). Other complications include infection and leakage of bone cement into the muscle and tissue. Cement leakage into the blood vessels may result in damage to the blood vessels, lungs, heart, and/or brain. Cement leakage into the area surrounding the spinal cord may result in nerve injury that can, in rare instances, cause paralysis. Please consult your physician for a complete list of indications, contraindications, benefits, and risks. Only you and your physician can determine whether this procedure is right for you.
Michael C. Connelly, M.D., is a physician with New England Neurological Associates in Lawrence, MA.
Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508.
Adachi JD, Ioannidis G, Olszynski WP, et al. (2002) The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disord 3:11.
Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991 Jun 1;114(11):919-23. PubMed PMID: 2024857.
Tillman J, Shabe P, Rose M, Elson P, Wülfert E, Ashraf T. Fracture Reduction Evaluation Study 24-month final clinical study report, August 27, 2010. Medtronic Spinal and Biologics Europe BVBA.