Osteoporosis and Vertebral Compression Fractures: What’s the Connection?
Osteoporosis is a disease that weakens bones by robbing them of their density—bone mineral density or BMD. Bones are alive and throughout life old bone cells are replaced by new bones cells. The process is called 'bone remodeling'. Unfortunately, osteoporosis upsets that balance as new bone growth can't keep pace with progressive bone loss. Loss of bone strength/density increases the risk for a bone to break, or fracture. The bones that are usually affected by osteoporosis in the spine are the vertebral bodies.
Osteoporosis is called a "silent disease" that may develop unnoticed for many years. Some people learn they have osteoporosis after a fracture happens. Alternatively, they may find out they already had a fracture after undergoing an X-ray or other imaging test for an unrelated reason.
In people with osteoporosis, spinal fractures are more common than hip and wrist fractures. The pain from a vertebral compression fracture (VCF) can be unbearable and lead to a significant reduction in quality of life.
- Not all VCFs are the result of osteoporosis, but a fracture may be the first sign of it.
Prevalence of Osteoporosis
According to the National Osteoporosis Foundation, 54 million Americans have osteoporosis. If you are age 50 or older and have broken a bone, speak with your doctor about a bone density test. A bone mineral density test quickly reveals how "dense" or strong your bones are. Your doctor may recommend an osteoporosis risk assessment test called the FRAX® tool. FRAX can help estimate your 10-year risk for fracture. This tool may be helpful in people age 50 and older, those diagnosed with osteopenia who have not taken osteoporosis medication.
Although the bone disease affects both men and women, studies suggest that approximately 1 in 2 women—compared to 1 in 4 men age 50 and older—will break a bone due to osteoporosis. Post-menopausal women are particularly at-risk for osteoporotic VCF because hormonal changes can affect estrogen levels, which help regulate bone-producing cells.
About Vertebral Compression Fractures
Osteoporosis weakens the inside tissue of bone—called cancellous or trabecular bone. This bone tissue resembles latticework and provides structural support and strength. Osteoporosis interferes with the bone remodeling process essential to keeping trabecular bone healthy, dense and strong. When a vertebral body loses its core density and strength, it is at risk to collapse, which compresses the vertebral body often into a wedge-shape. A VCF can cause spinal instability, and sudden pain that is severe.
Sometimes more than one osteoporotic VCF occurs. Often, VCFs develop in the thoracic spine; in the upper/mid back areas of the spine. Multiple vertebral compression fractures may cause loss of height and/or development of a hump or rounded back appearance. People who have osteoporosis (especially if severe) may experience a VCF with sudden high-velocity movements, such as coughing or sneezing. Even routine movements like bending over or reaching may cause an osteoporosis-related VCF.
Minimally Invasive Treatment
Although a VCF eventually may heal without treatment, usually the pain is too severe to wait for the fracture to mend. The pain from a spinal fracture is often so significant and debilitating, medical care may be urgently sought.
Vertebroplasty or balloon kyphoplasty may be recommended within the first week to reduce pain. While pain medications are helpful, the side effects may increase a patient's risk of falling and a new fracture.
Doctors who may perform vertebroplasty and/or balloon kyphoplasty include:
- Orthopaedic Surgeons
- Interventional Radiologists
- Pain Management Physicians
Depending on how and where the VCF is diagnosed may determine who refers you to a vertebroplasty or balloon kyphoplasty specialist. Doctors who perform these procedures have received extensive training and are knowledgeable about the potential benefits, risks and complications. Patients should feel comfortable about asking the doctor who will perform the procedure about their training, number of procedures performed and how often, as well as their personal rate of success.
Vertebroblasty and balloon kyphoplasty are two different minimally invasive procedures for treatment of vertebral compression fracture. Furthermore, both procedures help to stabilize the fracture by injection of bone cement into the VCF. The primary difference between the two procedures is kyphoplasty utilizes a balloon device to create a void to hold the bone cement, which may also help restore lost vertebral body height. The treatment can help relieve pain quickly.
Neither procedure prevents a new VCF from developing in adjacent vertebrae. Potential complications of vertebroplasty or kyphoplasty may include infection and cement leakage.
Prevention and Management Tips
It's never too late to take steps to help prevent or manage osteoporosis or reduce the risk for a vertebral compression fracture. If you are 50 years of age or older, talk to your doctor about your family history and risk factors you cannot control. If your doctor has prescribed a medication for osteoporosis, take it along with any supplements (eg, Vitamin D) recommended. Eat a healthy diet and regularly exercise. If you are prone to falling, take steps to make your home and/or office safer.