Osteoporosis & Compression Fractures

Osteoporosis is a decrease in bone mass, more commonly seen in women during the post-menopausal period. The bone mass decrease includes both the mineral component (e.g., calcium and phosphorus) and the organic component (e.g., protein) of bone. About 15 million to 20 million people have osteoporosis, and among them, more than 500,000 suffer spinal fractures as a result each year. These fractures can occur with minimal trauma such as a fall to the ground, or no trauma at all.

Symptoms & Imaging Evaluation

Back pain is the most common symptom of osteoporosis. Back pain and other symptoms of osteoporosis – like infections, other metabolic bone diseases, and benign or malignant bone tumors – can mimic the symptoms of other conditions. That is why imaging evaluation is crucial in confirming a diagnosis of osteoporosis, such as:

• X-rays show wedge or compression fractures of the vertebrae
• MRI or CT scans can further evaluate fractures
• Bone density tests confirm the presence of osteoporosis in most instances
• Bone biopsy confirms osteoporosis in some cases

Treatment Options

Fortunately, most spinal fractures due to osteoporosis are successfully treated with just medication to control the pain, but the underlying osteoporosis should also be addressed. The treatment of osteoporosis itself is rapidly evolving.

Nonoperative Treatment

Some of the therapies used to manage osteoporosis are:

• Bisphosphonates to help maintain and possibly increase bone mass
• Back braces to help control pain and may thwart scoliosis and/or kyphosis from worsening. Although braces usually do not correct the wedging of the bone, they do support the spine and may decrease secondary muscle spasm.
• Calcitonin to slow the breakdown of the minerals in bone.
• Combinations of calcium, vitamin D, and estrogen, though controversial, are still used.

Operative Treatment

May be necessary to control pain, in rare instances, to stabilize the structure of the spine, or decompress the nerve roots or spinal cord. New techniques to treat the problem of compressed vertebrae include:

• Vertebroplasty involves an injection of bone cement into vertebrae to improve the strength of the bone.
• Kyphoplasty, similar to vertebroplasty, except that a balloon is inflated in the vertebra to create a space before the filling with bone cement. Both procedures require at least sedation and local anesthesia but sometimes require general anesthesia. With both procedures, very tiny incisions are made under x-ray control. As with any other surgical procedure, there are certain risks.

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