Management And Treatment Of Osteoporotic Vertebral Compression Fractures
Due to significant loss of bone density in osteoporosis patients, fractures are common from falls or simple activities. One of the complications associated with osteoporosis is vertebral compression fractures (VCF). These may occur with movement, sneezing, or coughing. Successful management of VCF may involve conservative care or surgery.
Once a VCF occurs, medications will not fix the problem, but they can help prevent future fractures. Since certain demographics have a higher risk of developing osteoporosis, it is important to have regular bone density screenings to identify osteopenia or osteoporosis when it is in the early stages. Bone density screenings can also be used to monitor the effectiveness of the medication. There are several medications used to improve bone density. Each medication will have different dosing schedules. Some are weekly or monthly pills, whereas others are quarterly or yearly infusions. Less commonly, medications may be administered as subcutaneous injections.
The medications available work in one of two ways. Some medications reduce the speed that bone breaks down, which is the major culprit in osteoporosis. When osteoporosis occurs, it is typically because bone breaks down faster than it can be rebuilt. Other medications work on the rebuilding process by accelerating the rate at which bone can be rebuilt. Regardless of the medication used, the net result is stronger bones. In rare instances, some women may not be able to tolerate osteoporosis medications, and if they are post-menopausal without certain risk factors, estrogen therapy might be an option to reduce their risk of future fractures.
Physical therapy is necessary after acute VCF and fractures that may have been discovered haphazardly through x-rays for other problems. For acute fractures that are painful and limit movement, early treatment involves pain management, rest, and bracing. Once the person is able to resume some movement, PT is important to improve strength and pain. Part of the problem with prolonged inactivity is it makes osteoporosis worse because bone density and strength are continuously decreasing with prolonged inactivity.
PT involves several components. Strength-building is important to build bone density and prevent injury. People will also learn tactics for lifting objects to put less strain on their back and reduce the chance of future fractures. Additionally, exercises can improve gait and balance. When there are gait and balance problems, the risk of falls and future fractures is significantly increased. Part of PT will also be establishing an exercise plan to do at home. Walking is generally a good start because most people can do it and it also helps improve bone density. If you are able, your therapist will want you to add in light weights and/or resistance bands.
Surgery is generally reserved for people who do not show improvement in pain and function or for those with significant VCF. There are two types of surgery used to fix VCF: vertebroplasty and kyphoplasty (also called balloon kyphoplasty). These surgeries are similar and are used to repair the affected vertebrae. Both procedures can be done as minimally invasive procedures. A special material is used to fill in the gaps in the fractured vertebrae, which increases the integrity of the remaining bone by stabilizing it and alleviating pressure on the nerves or spinal cord caused by the fracture. Kyphoplasty takes the procedure a step further by inserting a small balloon into the foramen of the vertebrae and inflating it. The foramen is the opening in the vertebrae where the spinal cord is located. This allows the surgeon to create more space in the foramen and may return the affected vertebrae to their original height. When the vertebrae can return to their original height, this reduces the chance of spinal deformities after the fracture heals.
Osteoporosis makes people vulnerable to fractures from falls and everyday activities. VCF is a common complication associated with osteoporosis and successfully managing the condition can prevent future fractures and long-term disability. Talk to a surgeon if you think you need spinal surgery.