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Vertebral Compression Fracture Treatment
If you suffer from severe pain due to advanced osteoporosis, trauma or metastatic disease you may be interested in learning about how to help.
You may be a candidate if you experience...
Pain: Tends to be in the lower back but may occur in the upper back or neck.
Numbness, tingling, and weakness: Such symptoms could mean compression of the nerves at the fracture site.
Losing control of urine or stool or inability to urinate: If these symptoms are present, the fracture may be pushing on the spinal cord itself.
Seeking Medical Care- A doctor should evaluate any back pain in these cases:
- Any elderly person
- A person with cancer
- Anyone whose pain is exactly the same at rest as it is during activity
- A person with unintentional weight loss
Seek medical help at a hospital's emergency department if you have the following symptoms in association with back pain:
- Loss of control of urine or defecation
- Severe pain, numbness, or weakness
- High fever
Compression fractures are normally stable secondary to their impacted nature.
Traditional Treatment is Non-operative and Conservative
- Patients are treated with a short period (no more than a few days) of bedrest. Prolonged inactivity should be avoided, especially in elderly patients.
- Oral or parenteral analgesics may be administered for pain control, with careful observation of bowel motility.
- Muscle relaxants, external back-braces, and physical therapy modalities also may help.(1)
- Nonsteroidal anti-inflammatory drugs have been shown to significantly increase gastrointestinal bleeding in the elderly and must be used with caution.(2)
Advanced Treatment
People who do not respond to conservative treatment or who continue to have severe pain may be candidates for percutaneous vertebroplasty. Vertebroplasty was developed in France by Dr. Deramond and his colleagues in 1984. The procedure has been performed in the United States since 1995.
This innovative procedure helps reduce pain caused by vertebral compression fractures. Percutaneous vertebroplasty involves injecting acrylic cement into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body.(3) This procedure does not, however, restore the shape or height of the compressed vertebra.
Most patients can see marketable improvement in their quality of life six to 12 weeks after being treated for a compression fracture. In many cases they can return to a normal exercise program after the fracture has fully healed. A well-balanced diet, regular exercise program, calcium and vitamin D supplements,(4) smoking cessation, and medications to treat osteoporosis (such as bisphosphonates) may help prevent additional compression fractures. Age should never preclude treatment. Review indications and contraindications for this procedure.
Further PrognosisThere is good evidence that diagnosing and treating osteoporosis reduces the incidence of compression fractures of the spine.(4,6,1). Regular activity and muscle strengthening exercises have been shown to decrease vertebral fractures and back pain.(7) To further assist in back health, measures to prevent falls must be initiated by patients and their caregivers.
Family physicians can take a leadership role by assessing and addressing those factors that can increase the incidence of vertebral compression fractures in elderly persons, such as inappropriate or over-medication, use of restraints, unsafe home situations, and physical abuse.
For additional information about this procedure please review our comprehensive Frequently Asked Questions and the resource list below.
References
| 1. |
Silverman SL, Azria M. The analgesic role of calcitonin following osteoporotic fracture. Osteoporos Int 2002;13:858-67. |
| 2. |
Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999; 340:1888-99 |
| 3. |
Predey TA, Sewall LE, Smith SJ. Percutaneous vertebroplasty: new treatment for vertebral compression fractures. Am Fam Physician 2002;66:611-5. |
| 4. |
Ullom-Minnich P. Prevention of osteoporosis and fractures. Am Fam Physician 1999;60:194-202. |
| 5. |
Reid IR. The role of calcium and vitamin D in the prevention of osteoporosis. Endocrinol Metab Clin North Am 1998;27:389-98. |
| 6. |
Maricic M, Adachi JD, Sarkar S, Wu W, Wong M, Harper KD. Early effects of raloxifene on clinical vertebral fractures at 12 months in postmenopausal women with osteoporosis. Arch Intern Med 2002;162:1140-3. |
| 7. |
Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 2000; 85:4118-24. |
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