OSTEOPOROSIS AND VERTEBRAL COMPRESSION

Older patients and those with osteoporosis have a high risk of spinal fractures, particularly vertebral compression fractures. The main reason being low bone mass and strength, as well as an increased risk of falling. In these patients, vertebral compression fractures can occur during simple activities of daily living, such as coughing, sitting down quickly, or taking a step wrong.

As with many osteoporotic fractures, compression fractures are more common in women than men; however, the consequences are severe in both. Patients may experience acute and chronic pain, kyphotic deformity (increased forward curve of the spine), decreased quality of life, increased anxiety, depression, and death. Our geriatric doctors and nurses are involved in their care.

Osteoporosis is weak bones that usually occur with people who are more than 50 years of age. Hip fractures are also common with trivial fall and can lead to death. Upto a quarter of them will have at least one vertebral fracture in their lifetime. Although most fractures heal within a few months, some people have pain and disability that fail to respond to conservative therapy, and some require hospitalization, long-term care, or both. Therefore, interventions that effectively manage pain and shorten recovery time would be of great benefit.

Vertebroplasty, a minimally invasive procedure that involves a percutaneous injection of special bone cement into the affected vertebral body, has been advocated as a treatment for painful osteoporotic vertebral fractures. It helps to stabilize the spinal compression fractures and to stop intolerable pain caused by the fracture. Not all people with fractured vertebrae are candidates for the procedure, however patients need to be carefully selected based on the MRI scans and general condition.

The procedure can be done under local or general anaesthesia as a day procedure and takes about an hour. The cement hardens quickly, concealing the fragments of the fractured vertebra and stabilizing the bone. Most patients can go home the same day or next day. The success rate worldwide is as high as 80-90% in relieving pain immediately. The risks with this procedure are negligible and can be discussed with the doctor.

Elderly people with sudden onset persisting back pain lasting more than a few days without a fall should consult a spine specialist.