The Impact of Vertebral Compression Fractures

Author: Access Health

The National Osteoporosis foundation estimates that 10 million Americans have osteoporosis, with a fracture occurring every three seconds worldwide. Fractures in the vertebra of the spine are common in people with osteoporosis and often go unnoticed until consequences such as severe pain or lack of mobility occur. On today's show the impacts of osteoporosis: what you need to know about the often silent disease.

I’m Ereka Vetrini, Access Health starts now. Elderly related osteoporosis is exceedingly high, if you go back ten years and forward ten years the osteroporatic patient population is an issue. This is a huge demographic. Osteoporosis means porous bones and is a disease that causes bones to become weak and brittle often leading to fractures of the hips, spine and wrists. I see a lot of elderly people and they're scared and they hurt because they've gone from being an active person in their community to now there, they can't walk they're in a wheelchair.

My name is Joyce Wagoner and I am 76 years old I fell in a store and there was water on the floor and I slipped and went down on one knee and I coul feel or hear it pop but I didn't I thought it was my knee instead of my back. I did go in and have the knee check but I didn't have the back check I thought oh I had just pulled my back and you know it hurt but not severe. I was riding in the car with my daughter Janice and when she'd go across a railroad track or a bump I would just hurt something terrible and then I couldn't sleep at night because I couldn't lie flat. My name is Eddie Lou Halsey and I'm 92 years old and I live in Guthrie, Oklahoma. I tackle anything that a woman my age would do and some things that probably women my age didn't do. I drove myself, I went to all the functions of an that I need to go to, and whenever anybody needed anything from, I'd pitch in. I was in the church and we had had a dinner and I had a casserole that I was carrying and going home, and I tripped on a rubber mat that they had in front of the door and just went, just fell flat hit my head and knocked myself out. I knew that there was something wrong because my back was hurting terribly and if, I was taken home and it never did quit hurting, so I knew I had to do something.

I didn't know that I had osteoporosis no one had ever really pinned it down to that. So I wasn't thinking about that but I certainly thought about it after I fell. (music.) Joining me today to discuss what we need to know about the prevention, early diagnosis and treatment of osteoporosis is Dr. Heather Hofflich professor of medicine at the University of California, San Diego Health Sciences.

The Impact of Vertebral Compression Fractures

Welcome doctor, hi Ereka, thanks for having me today. I’m so glad you're here we have so much to cover in this show so let's start from the very beginning what exactly causes osteoporosis? Osteoporosis is a silent disease most times until an actual fracture occurs and actually the incidence of osteoporosis annually is even more than the incidence of a stroke, heart attack, and breast cancer combined. So it's a very common problem as we age we lose our bone density, and thus that can lead to fracture.

There are other non-modifiable causes of osteoporosis, having a family history is an extremely common reason, if your mother or father were to fracture a hip or have osteoporosis your chances are much higher of also having osteoporosis, as women reach menopause we lose our estrogen and Men as they age also have declining testosterone levels, and this too leads to reduce bone density and osteoporosis the other risk factors there are many modifiable ones and that's what we work hard on in our clinics to prevent further bone loss some of them include cigarette smoking, which is directly toxic to the bone, alcohol use more than two glasses a day in woman and three glasses in men is something that we can change poor diet lack of exercise so there are many things that we can change and work on and help prevent osteoporosis. Doctor how is osteoporosis diagnosed? The best test to diagnose osteoporosis is a bone density scan or DEXA scan that should be done in all women aged 65 years or older as per the National Osteoporosis Foundation guidelines and also men greater than age 70 and older so that we can detect the silent disease. It seems like in the elderly it's very common to have fractures of the hip or the wrist is this osteoporosis? Typically it is osteoporosis and spine fractures are definitely the most common fractures that are seen. How do we know if we have a spinal fracture what are some of the signs? Debilitating pain can often be a signal that someone has a fracture and so when I see a patient that is in an awful amount of pain, I we'll go ahead and get an x-ray however two thirds of spine compression pressures are silent and are picked up incidentally on x-rays so we need to have another way to try and find these it is important that we intervene at the time of the fracture and that is where the role of a hospitalist comes into play, they are seeing the patient submitted through the emergency room that have the fractures and it's important that they identify and directly provide care for these patients.

So it sounds like the hospital if is a crucial part of the process of getting to the patient and we're going to take a short break but first Access Health caught up with Dr. Syed for more on the hospitalist role in osteoporosis, take a look. Patients come to the ER because pain, majority of the time, when pain goes away people think that we can treat it everything is fixed and there's no further worries and the life goes on That's a misperception because if you don't plead the underlying process which is causing the problem you'll get back to the years in a matter of time. If you have a fracture, you have significant osteoporosis and or the period of time is going to get worse and you'll have more fractures and your quality of life is going to go down. Coming up treatment options for the impact of osteoporosis. (music.) (Music) Welcome back I'm here with endocrinologist Dr.

Heather Hofflich and before the break we were talking about the diagnosis and impacts of fractures related to osteoporosis, doctor can we now talk a little bit about the treatment for spinal fractures? There are both non-surgical and surgical treatments for spinal fractures, at UCSD where I work we're very lucky to have a wonderful orthopedics team, if a patient fractures whether it be in the ER, the inpatient team or outpatient, the patients are referred to orthopedics and seen within 24 to 48 hours particularly with spine fractures the patient is seen immediately, they are put in a brace, given proper exercises and instructions, and they are given a complete pain management program and seemed back with an appropriate plan. This has been wonderful and a great resource for our patient there is a minimally invasive surgeries that are possible to infer them reduce their pain. Thank you Heather we're going to see you a little later in the show and let's go now to Dr. Douglas Beal, Chief of Radiology Services at clinical Radiology of Oklahoma to learn more about this minimally invasive procedure.

The issue about patients with vertebral fractures, pain is that they lie in bed, that they get pneumonia, blood clots to the lungs, DVTs and they typically don't do better, they do poorly. End these patients die at a very high rate so your typical patient is they're distraught with pain you can see a broken arm or broken leg but you can't see a broken vertebrae and so people don't understand until you truly have one or experienced a broken bone. Patients will exhibit specific symptoms they're very textbook, it's a sharp shooting pain, it's much pain with movement it's pain with any transition type pain from sitting to standing or sitting to lying or breathing. So vertebral plasticies we need to put a needle into a vertebral body inject medical cement and that's a tried and true methods been present for a long time - kyphoplasty and balloon kyphoplasty, we put the needle in and then we balloon the vertebra try to make it look more normal, we call these vertebral compression fractures because they're compressed top to bottom, we inflate the balloon it raises it back up from top to bottom reestablishes the height of the vertebral body and it also creates area within the bone and cavity so whatever we injected revelat controls, the cement better.

Cement goes to the path with least resistance. The patients that we see are typically coming to us from their primary care physician or from a specialist typically your neurosurgeons or orthopedic surgeons or endocrinologist even primary care doctors will put a patient in a brace because they see the fracture they understand it's a broken bone and they are going to the adage that the bone turnover will then heal the bone but you're dealing in an older population with osteoporosis where the bone turnover is not fast at all it's not like a 16 year old that breaks an arm in a soccer tournament, this is a this is a older person that after menopause or later in life you don't turn your bone over, it just don't heal fast. Average patient I see will have a fracture between two and four months old, used to be worse used to be six months in a year, and patients that survived that, survived the decondition are able to be treated.

After I fell the pain kept getting worse and worse and I knew there's something, that there was something wrong and it took me about three weeks, two or three weeks I believe before I went to Dr. Beal and he immediately knew what it was. The MRI showed 3 fractures and then he told me I needed to have the kyphoplasty. He did an MRI and that's why he decided I had done had, had and had broken my vertebras, crushed them. We diagnosed a fracture with either x-ray CT or MRI and we treat them based on the presence of a fracture associated with pain, a fracture that's important, one that is is one that is symptomatic one that hurts so a fracture combined with pain combined with patient debilitation equals need for treatment. So surgical procedure for someone that comes in with a vertebral compression fracture include born kyphoplasty and this is done when the skin is numbed and we identify the appropriate starting position from x-ray live x-ray or fluoroscopy. The kyphoplasty is accessing the fracture putting the balloons and trying to make the request partiro body look more normal, raise it up to normal height. We insert the balloon inflate the balloon with contrast something you can see on x-ray and then once the balloon is deflated we take it out and we inject the cement and then after the fillings complete we wait for the cement to harden and so it hardens completely in about 20 to 25 minutes, by the time we remove the needles the cement is hard enough to support lots of weight and the patient is immediately able to roll back over onto the gurney to go to the holding area the waiting room and recovery.

There are risk to the procedure including serious complications including 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. See the end of this segment for important safety information. What I see in the recovery room and recovery period is that patients are resting and they feel better and they're able to sleep and they're able to get dressed and they're able to to move about. When I came out I could tell it was fixed.

Take it easier for a couple of days but there really no restrictions. I walked in painfully, but after I had the surgery and they took me to a room I was pain-free, I did not feel any of the pain anymore and then when they wanted to wheel me out and wheelchair I said I will walk so I walked to the car and didn't have any problem at all, I went home that evening. After invertible augmentation recoveries not much people were a little sore three or four days after the surgery, but it's not without complications. The largest trial ever done 354 patients, number of complications or adverse events, 1.4%.

It gets them out of pain, it gets them back to their daily activities of living, it helps them be part of the community again. If you have one fracture you have about a five times increased risk of another one, two fractures goes up to 12 times, so I usually tell people it's not if it's when. I think it was probably a month later that they found the other fractures and had to have that taken care of and then I've been free of pain ever since.

Two days later I believe it was I coughed or something, anyway I've fractured the vertebra right above the one he fixed and he went back in and fixed that one and then I was fine and I have been fine ever since and if I ever have another fracture, I know it can be fixed and I will recognize it immediately. Joining us now is Michael Switzer an interventional therapy consultant, welcome Michael. Thank You Erika. So tell me as an interventional therapy consultant what does your job entail. Well we wear many hats, really our foremost role is to make sure that patients have access to balloon kyphoplasy. So we just watch Dr.

Bill perform a balloon kyphoplasty, tell us about the clinical evidence behind it. We've had many patients that have been involved in our clinical trials, most recently a study of 300 patients where roughly half of them received conservative non-surgical management and the other half received balloon kyphoplasty In that study they found that within the first week the patients that received kyphoplasty had a three times greater improvement in their pain. At one month those patients reported having a four times better improvement in their quality of life and in that first month they also reported having five fewer days with limited activity, versus the non-surgical management patients. Those are great numbers, it sounds like a wonderful option for the patients you support. Thank you Michael for stopping by, and we'll be back in just a moment so stay with us. [Music.] [Music.] We're back and I'm here with endocrinologist Dr.

Heather Hofflich, so Heather so far we've talked about the non-surgical and surgical treatments of spinal fractures, but can we now talk about the treatment of osteoporosis as a whole. There are many FDA approved osteoporosis medications and they can come in oral, intravenous, or injectable forms. The goal of therapy is to actually stop the breakdown a bone and there is one therapy that actually truly builds back bone density, these medications are so important to reduce the risk of fracture and if somebody has osteoporosis I highly encourage them to speak with their physician and to consider one of these therapies.

So doctor I know there's no cure for osteoporosis but what can we do to prevent it. There are many things that we can do to prevent osteoporosis and improve our bone health. Calcium is one of the building blocks of bone and it is a very important part in building bone density. What I do in my office with my patients I have them look at the National Osteoporosis foundation calcium calculator and I have them go home and calculate how much they really are getting in a normal day. If someone is not getting enough calcium their diet then supplementation is okay as well.

Vitamin D is another important building block for our bones, another important component of bone health is exercise and by this we mean weight-bearing exercise; walking, jogging, elliptical. I always educate my patients in the exam room about protecting themselves from a fall. Seventy-five percent of falls cause a fracture and that's what we're trying to prevent. There's a great handout on the National Osteoporosis foundation website that teaches people about some tips to prevent Falls. Doctor thank you so much for spending time with us today and giving us so much great information. Thank you to all of my guests and especially our patients for sharing their personal stories.

For more information on all the information we discussed on the show today you can visit spine-facts.com or the National Osteoporosis foundation website at nof.org, and of course you can log on to our web site access health dot TV, see you next time. Balloon kyphoplasty is a minimally invasive procedure for the treatment of pathological fractures of the vertebral body. Due to osteoporosis, cancer or benign lesion, there are risk to the procedure including, serious complications including 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. Cemnent leakage into the area surrounding the spinal cord may result in nerve injury that can in rare instances cause paralysis. A prescription is required. This therapy is not for everyone, please talk to your doctor about the risks and benefits of this procedure and to decide whether this procedure is right for you.

Results may vary, for more information please call Medtronic at one seven six three five oh five five zero zero zero and or consult Medtronic website at Medtronic dot com [Music.].

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