Spinal fractures often warning sign of osteoporosisWritten by Staff Reports | | email@example.com
By Sura Khuder
Nine million Americans currently live with osteoporosis and another 48 million with low bone density.
This puts 57 million Americans at risk for fractures and other complications, according to a recent report from the Surgeon General.
One in two Americans older than 50 will be at risk for low bone mass and fractures by 2020, according to the report.
“With the aging of the population and aging of the baby boomer group in particular, those numbers will only continue to increase,” said Dr. Andrea Singer, clinical director of the National Osteoporosis Foundation.
Spinal fractures are the most common type of osteoporosis-related fracture with an estimated 700,000 occurring each year in the United States, Singer said.
For someone with severe osteoporosis, a spinal fracture can be triggered from an action as small as a cough or a sneeze, said Dr. Milan Herceg, a spine surgeon in the Columbus area.
The most pronounced symptom of a spinal fracture is pain, which is often written off as simply being due to old age, Herceg said.
An estimated two-thirds of spinal fractures go undiagnosed, said Dr. Thomas Andreshak, an orthopedic surgeon at Consulting Orthopaedic Associates in Sylvania.
“It tends to be an insidious fracture,” he said. “People blame a lot of the pain they have on arthritis, but their arthritis pain is consistently there and it doesn’t get better and they just live with it.”
While most people are aware of the consequences of a hip fracture, Singer said not many people know about the consequences of spinal fractures, which can be life-altering for a patient.
Many people who have vertebral fractures experience decreased quality of life, increased digestive or respiratory problems, increased anxiety, depression, changes in self-esteem and increased mortality, Singer said.
Andreshak said he offers three options to patients who experience a spinal fracture: Do nothing and wait for the fracture to heal (the current standard treatment), wear a brace around the abdomen or undergo an invasive procedure called balloon kyphoplasty.
Untreated, a spinal fracture should be able to heal on its own within three to four months with no invasive procedure necessary. A small percentage of people, however, are not able to heal the fracture because of osteoporosis, so the fracture keeps collapsing, Andreshak said.
Some spinal fractures may collapse immediately while others collapse over time, resulting in a condition called kyphosis, or rounded back, which can lead to medical issues such as lung compression, abdominal compression and development of an emphysema-like breathing problem, Andreshak said.
Balloon kyphoplasty is available for patients seeking to relieve significant pain from a spinal fracture. In this procedure, a balloon is used as a jack to set the fracture and create a cavity, and then thick cement is used to fill the crevice.
Shirley Podach, 79, of Fostoria decided balloon kyphoplasty was the best option for her. After falling and fracturing her lower back three months ago, Podach experienced extreme pain exacerbated by her osteoporosis. After going six weeks without treatment, she underwent balloon kyphoplasty performed by Andreshak.
After her surgery, she said the pain she experienced from her spinal fracture and past osteoporosis was gone.
However, not everyone is a candidate for the procedure, Singer said.
“Clearly for patients who have significant pain and pain that is not responsive to nonsurgical management, those who have disability and deformity, and in those where the pain correlates with the vertebral fracture and we make sure there aren’t any other causes for the pain, then minimally invasive procedures like balloon kyphoplasty can make a significant difference in terms of relieving pain, improving quality of life, potentially stabilizing compression fractures and increasing function,” she said.
Andreshak has performed approximately 2,500 balloon kyphoplasty procedures and estimates about 25 physicians perform the procedure throughout the area.
While the procedure may relieve some patients of significant pain, many physicians have chosen to opt out of it.
Herceg said he no longer performs balloon kyphoplasty, preferring to treat the majority of patients with activity modification, medication and time.
“There are complications that occur with [balloon kyphoplasty]. If you put bone cement next to someone who already has soft bone, there is a lot of thought that it will increase their risk for more fractures than if they never had the procedure,” Herceg said.
However the spinal fracture is treated, the underlying problem, osteoporosis, often goes unrecognized.
A vertebral fracture is consistent with the diagnosis of osteoporosis, even in the absence of a bone density diagnosis, Singer said.
“If the bone density is normal but somebody has a vertebral compression fracture, they have osteoporosis, which then makes them a candidate for treatment with osteoporosis medication with pharmacologic strategies, and this is very important,” she said.