Osteoporosis is a silent disease. Most sufferers do not know they have osteoporosis until they sustain a fragility fracture. This usually occurs with a minor fall which should not result in a fracture for a person with normal bone density. For those whose bone density is low, it may result in a fracture of the vertebra of the spine.
Osteoporotic compression fractures of the spine can be very painful. Sometimes the patient may not even remember having fallen as the impact was very minor. But they develop increasing back pain that restrict their activities.
- Patients tend to be elderly and female.
- A common complaint is severe lower back pain worse on movement, change of position e.g. getting up from bed.
- The trauma to the spine could be very trivia such as lifting a pail of water. Some patients do give a history of a minor fall.
X-rays of her thoracic or lumbar spine may sometimes show a compression fracture.
An MRI scan is useful to determine the site and age of the compression fracture. New fractures tend to show bony oedema signal on MRI scan.
A lot of patients will improve with rest and oral pain medications.
Some patients have severe unbearable fracture pain not well controlled by pain medications. A possible treatment would be percutaneous vertebroplasty under sedation and x-ray (fluoroscopic) guidance.
This procedure is done minimally invasive and involves injection of bone cement into the fractured vertebral body via the bony pedicles.
Risks of this procedure include:
- Infection of the disc called disciitis
- Extrusion of bony cement out of the fracture into neural canal damaging nerves
- Embolism of cement to the lungs
- Future adjacent segment fractures
It is important to treat the underlying osteoporosis.