It is becoming common knowledge that our bone strength decreases as we age. Typically the condition is known as osteoporosis, alias thinning of the bones. Older people with osteoporosis commonly suffer hip wrist and spinal fractures. We are discussing the spinal fractures in this blog, prevention and treatment of other fractures at another time.
The vertbral bodies are shaped like short cylinders and they support the body against gravity during any weight bearing activity. When the vertebral bodies loose strength and become osteoporotic even small trauma can cause a compression fracture in which the front of the bone is pushed down and the posterior (back ) part is intact. This causes severe pain but usually does not cause any nerve problems. Treatment used to consist of bedrest, bracing and time.
There are new treatment options including calcitonin injections and bone cement (vertebroplasty and kyphoplasty) as well as the standard pain medications and anti ostroporosis drugs. Recent articles from the AAOS have explored the most effective treatment protocols. The results are powerful. In a neurologically intact patient symptomatic treatment with rest, time pain medications has been augmented with calcitonin a hormone which helps builds bones. Usually this should be done for one month before it is deemed a failure. The next level of treatment is flet to be kyphoplasty a minimally invasive treatment in which the fracture is put back into normal shape with a balloon like device and then fixed with bone cement to stabilize the bone in the corrected position. Vertebroplasty ( a smilar treatment without the balloon correction) does not work as well. There is no invasive surgery indicated in the neurologically intact patient
In the long run drugs to prevent further osteoporosis are needed of caurse as well as instruction in body mechanics to prevent further fractures
