Osteoporotic Compression Fractures

Osteoporotic Compression Fractures

Osteoporosis is a condition characterised by loss of the mineral content of bone leading to weakness of the bones. The cancellous bone (spongey bone) is affected earlier than the cortical bones (compact bone) and in the spine this means the vertebral body is most commonly affected. In particular the vertebral bodies of the middle thoracic region and upper lumbar region are most typically affected because they are loaded in compression due to the normal kyphotic curve to this area of the spine. When the vertebral body fractures it tends to collapse into a wedge shape with most of the collapse at the front. These are often called wedge compression fractures. This compression tends to stabilise the spine but over time and with multiple fractures it also leads to further kyphotic shape to the spine.
Back pain is the most common reason patients seek medical attention. Thankfully the pain from osteoporotic spine fracture does typically settle over a few weeks to a few months. Treatment of the pain is largely symptomatic with activity modification and simple analgesia. Treatments that inject cement into the vertebra to reduce pain are controversial and 2 recent large randomised studies have not shown any meaningful advantage to this type of treatment. There is also some concern that the cement can stiffen the spine and lead to further fractures in other areas of the spine. Cement leakage is also common and rarely can compromise the spinal cord or nerves.

The other aspect of treatment is prevention of further fractures. Whilst osteoporosis is in many ways a natural consequence of ageing, there are a number of conditions that can accelerate the normal age-related bone loss and some of these have specific treatments. Your doctor may need to do some tests to look for these conditions. After an osteoporotic spine fracture most patients would be recommended to take medication to slow down bone loss. There are many agents on the market that can do this and your general practitioner should be able to recommend the best treatment depending on your circumstance.

Spine surgery rarely has a role in the management of this type of fracture.