Osteoporotic Compression Fractures and Vertebroplasty
Osteoporosis increases the risk of fractures. This can happen following a fall for example but can also involve the bones in the spine, known as the vertebrae, even in the absence of any injury. These osteoporotic compression fractures (also known as wedge fractures) are very common in the older osteoporotic population. Assessment of bone mineral density (with DEXA) allows identification and treatment of osteoporosis and aims to reduce the risk of such fractures. Significant pain relief is expected in over 85% of cases. Stabilisation and pain control helps preserve mobility and function.
Osteoporotic Compression Fracture Symptoms
Spinal fractures from osteoporosis usually cause sudden severe pain in the back which can spread around the sides and the front of the chest or abdomen. This pain can be difficult to control even with very strong painkillers.
What causes osteoporotic compression fractures?
Osteoporosis is most often due to vitamin D deficiency but can be due to more complicated medical conditions such as liver or kidney disease. Compression fractures can also occur in the context of cancer spread to the spine but these can usually be distinguished on an MRI or CT scan.
How is a compression fracture diagnosed?
Whilst compression fractures are usually seen on x rays, they are more accurately assessed on a CT or MRI scan. If treatment, such as vertebroplasty, is planned then CT is essential in establishing suitability. If the age of the fracture is unclear then MRI is very helpful in checking whether the fracture is recent or older.
Do I need treatment?
No. Treatment is indicated if pain is not controlled well. In some cases, there is also a good reason to avoid the use of opiate painkillers and so treatment is indicated. If pain is minimal and well controlled then treatment may not be required.
How is a compression fracture managed?
If osteoporotic then you will have to have your bone mineral density assessed. A trial of painkillers is started. If there is inadequate improvement you may be referred for vertebroplasty.
When you are seen by the IR specialist you can trust that you will be only offered treatment if it is thought to be your best option.
Initial patient enquiries are welcome. Send us an email or call and we will email a patient information form for you to complete.
Ask your GP to refer you for a consult. Note that consultations without a referral cannot be claimed from Medicare.
After listening to your symptoms and taking a medical history we will discuss further investigations or scans needed to establish whether you are a candidate
This will be discussed at time of consult but may include:
- CT scan – to assess the full extent of the fracture
- MRI – to check whether there is any risk of nerve damage from the fracture
- DEXA – to check for osteoporosis
The treatment takes about 90 mins.
Vertebroplasty is done using sedation and local anaesthetic.
This is a complex and difficult procedure performed by a specialist interventional radiologist – an expert in this area. A special needle is used to enter the fractured bone through the skin on the back. Once in position, a special bone cement is slowly injected to help restore strength to the broken bone.
You will stay in hospital until your pain is improved and your mobility is at a level where you are safe to be discharged. If you are previously well and an outpatient then this may be a short period, for other patients this can take longer.
This depends on your baseline function and fitness. We expect some improvement in pain in the first day or so. You can begin mobilising and physio the next day. It is important to prevent muscle and strength loss so rehab is important.
The research into vertebroplasty has shown some conflicting results, with some studies showing that it is no better than placebo. Recent trials however which focus on patients with acute fractures show significant improvement in pain which is more than in those patients who underwent a sham procedure.
In some cases, there can be further vertebral fractures. We do not know if this is because of the treatment or whether they would have happened anyway because of the osteoporosis.
There is also a potential risk of some nerve symptoms if the cement leaks around the nerve roots.
An effective method of pain control in well selected patients with spinal osteoporotic compression fractures.