One of the most common complications of osteoporosis are vertebral compression fractures. These osteoporotic fractures can be painful and diagnosis and pain management for can sometimes be tricky.
What are the Symptoms?
Almost two-thirds of those with a vertebral compression fracture will have no symptoms and will be diagnosed incidentally. Some symptoms of vertebral compression fractures can include back pain, loss of height, or tenderness in the middle of the spine. Often a person with this type of fracture will experience back pain very suddenly after sneezing, lifting, or coughing.
What Complications Can Result?
There are a number of complications associated with vertebral compression fractures. These include muscle weakness, pressure sores, osteoarthritis, bone loss, difficulty in breathing, problems with urinary retention, and spinal cord compression.
How Does a Doctor Diagnose the Condition?
The doctor will first do a physical examination, including a neurologic assessment. Depending on what the doctor may feel during the physical examination, an MRI may be necessary. This is to help the physician distinguish chronic vertebral compression fractures from malignant fractures. The MRI can also help the doctor understand when the fractures first appeared and exactly where the fractures are located. If the doctor suspects osteoporosis, he or she may also order a dual-energy x-ray absorptiometry to see if osteoporosis is present and how far it has progressed. Depending on what this test shows, and especially in patients who are younger, the doctor may then include a blood count and metabolic panel as well.
What Are the Goals When Treating This Type of Fracture?
There are three goals. First, it is important to treat the pain. Second, it is important to prevent any future fractures. Finally, the doctor will be interested in doing everything possible to help restore full physical function. All treatment for vertebral compression fractures begins with a consultation to help the patient understand the goals and also the risks involved in treatment. That’s because there are both pros and cons to conservative treatment and to aggressive treatment.
What is Conservative Vertebral Compression Fracture Treatment?
This type of treatment has a 50% chance of relieving the pain within the first three months. If this is achieved, there is then a 95% chance that this pain relief will continue. Conservative care means encouraging mobility as soon as the patient can tolerate it, but with bed rest when pain becomes difficult. Medications will include over-the-counter painkillers, lidocaine patches, and muscle relaxants. Physical therapy is prescribed until pain levels improve. The doctor may prescribe a brace for the first few weeks in order to help patients improve posture and strength. Some cases may also merit nerve root blocks that can provide temporary pain relief to allow patients to recover mobility more easily.
What is the More Aggressive Treatment?
More aggressive treatment for vertebral compression fractures is percutaneous vertebral augmentation. This is usually only considered when patients are getting no pain relief from conservative care. One such type of treatment involves injecting a liquid cement into the collapsed vertebral. The other type involves injecting a balloon and inflating it until the proper vertebral height is restored. There are complications and risks with both of these procedures and studies have shown mixed results. Some demonstrate that patients can significantly improve their quality of life and physical abilities, while others seem to suggest that the risks may not be worth the results. This is why it’s important to discuss any intervention and treatment with a healthcare professional and pain management physician.
Is There Any Way to Keep These Fractures From Happening?
Prevention should begin early and should include getting plenty of calcium, especially for women, and plenty of vitamin D. It’s also important for people to do as many muscle strengthening and weight-bearing exercises as they can tolerate. Excessive consumption of alcohol or smoking can both increase the risk of developing osteoporosis and of vertebral compression fractures. There are some medications that have proved useful in preventing osteoporosis, and those at most risk–especially post-menopausal women–should discuss this with their personal physician.
It is possible to treat these fractures effectively and to get relief from the pain. If you’re experiencing any of the symptoms of vertebral compression fractures, discuss the matter with the spinal health professional today.