Osteoporotic Fracture- presentation

• Sudden onset pain in thoracic or lumbar spine• Minor trauma• Sometimes there is no trauma• A T10 fracture can cause pain in the lower

lumbar spine- so palpate the whole spine• A wedge fracture on xray may be tumour or an

osteoporotic fracture- so an MRI scan is essential

Management• Blood tests: ESR, CRP, Bone

Chemistry, Serum Electrophoresis, Renal and Thyroid function, Vitamin D levels.

• Rule out secondary causes and tumours

• MRI scan and Xray• Consider a Bone Density Scan• Advise rest and pain killers• If pain not settling in 6 weeks

refer to spinal unit

COMMON SECONDARY CAUSES OF OSTEOPOROSIS• Renal problems• Diabetes• Thyroid dysfunction• Early menopause• Steroid usage• Drugs for Epilepsy• Parathyroid dysfunction

Epidemiology

300,000 hip fractures/yr USA.700,000 spinal fractures/yr.1/3 new, 2/3 old.14 bed days/fracture.20% collapse can progress to 70%

collapse.Sex: 75% women .At 80 same incidence as men.

Problems after Vertebral fractures• Transient Ileus• Urinary retention• Pain• Problems with

immobilization

• Kyphosis• Muscle deconditioning• Insomnia• Depression• Protuberant abdomen• Decreased pulmonary

function• Increased mortality0.5% risk of paraplegia

23% increased mortality in women > 65years with Vertebral Compression Fractures compared with age matched controls.

KADO et al. Arch Intern med. 1999

9% reduction in Forced vital capacity per thoracic compression fracture

Vertebroplasty- Bone Cement injection into vertebral body

• Originated in France – 1986• 70-90% pain relief• 1-6% risk of complications

How does Vertebroplasty work?

• Reduced micro-motion and restoration of load transmission

NEEDLES PLACED IN VERTEBRAL BODY UNDER XRAY CONTROL

NEEDLES PLACED IN THE VERTERAL BODY UNDER XRAY CONTROL

BONE CEMENT BEING INJECTED INTO VERTEBRAL BODY

XRAY MONITORING OF CEMENT PLACEMENT THROUGHOUT

AP XRAY OF CEMENT IN THE VERTEBRAL BODY

F= 67. 6 year H/o back pain- 90% better after the procedure

Results

• Significant pain relief is seen in 75-90% of osteoporotic fractures

• And in 59-86% of malignant fractures.• Increased mobility• Reduced analgesic requirement• Results are sustained over time• Complication rates are low and include

cement leakage