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Spinal
Fractures: Quick Primer
Spinal fractures are breaks in the bones of the spine (vertebrae). The most common cause of spinal fractures is osteoporosis. Osteoporosis is a disorder characterized by low bone mass and poor bone structure, leading to an increased risk of fracture. Spinal fracture can also be caused by bone cancer, a tumor pressing on the spine, or other diseases or conditions that affect bone, such as osteomyelitis (infection of the bone), endocrine disorders or inflammatory arthritis.
Osteoporotic
spinal fractures occur because the vertebrae have
become so fragile that little or no stress can cause
one or more of them to crack or break.
If
osteoporosis is left untreated, multiple spinal fractures
can occur over time and result in curvature of the
spine, known as kyphosis or "dowager's
hump." Kyphosis can lead to progressively debilitating
symptoms, including difficulty breathing, walking,
eating or sleeping properly.
According
to the National Osteoporosis Foundation, approximately
700,000 spinal fractures occur in the United States
every year. These fractures don't occur just in the
elderly; women as young as age 50 can have them. Fragile
bones break easily, and once one spinal fracture has
occurred, a person is five times more likely to suffer
subsequent fracture(s).
Bone
mass contributes to bone strength. Throughout your
life, your bones, which are composed of living tissue,
continuously undergo a process whereby old bone is
broken down and replaced by new bone. This process
is known as "remodeling."
A woman has acquired 98 percent of her bone mass by the time she reaches age 20. Bone mass remains stable until mid-life, when both men and women experience age-related declines in bone density. Estrogen plays a major role in maintaining bone mass and structure. Women lose 20 percent of their bone mass in the five to seven years following menopause as levels of estrogen in the body drop.
If you have irregular periods or absence of periods, your lifelong production of estrogen is lower, and your bone density may be affected. Bone loss in postmenopausal women is usually greatest in the spine, hips and ribs.
Your
risk of developing osteoporosis is related to factors
other than changing estrogen levels. Some of these
factors are lifestyle-related and within your control,
such as being physically active, getting enough calcium
and vitamin D, not smoking or drinking excessive alcohol.
Other factors, such as a family history of osteoporosis,
are obviously not within your control. (See "Diagnosis"
section below.) To learn more about your possible
risk for spinal fractures, take the Spinal
Fracture Risk Quiz. The good news is that your
risk of osteoporosis and fracture can be reduced at
any age.
Signs
and Symptoms
Because the symptoms of spinal fractures can be easily
missed or mistaken for something else, these fractures
often go undiagnosed. That's why it's important to
be aware of the spectrum of spinal fracture symptoms
and to talk to your health care professional if experience
any of the following:
- Sudden
back pain: Spinal fractures related
to osteoporosis often occur during a routine activity,
such as opening a window, stumbling, or twisting
your back while lifting an object off the floor.
Many people experience sudden, immediate pain
right after the fracture occurs. Standing or walking
usually makes the pain worsen, and lying on your
back may make the pain lessen. This severe pain
may last for a period of four to six weeks. Once
the fractured bone heals, the severe pain may
turn into a chronic, dull or achy pain, localized
in the area where the fracture occurred. This
pain may eventually go away after a period of
several weeks or months, though the risk of another
fracture continues. However, it is also possible
to fracture a vertebra (or multiple vertebrae)
in your spine and feel no pain or only vague,
diffuse back pain, which you may mistakenly blame
on muscle strain or soft tissue injury, or just
the "aches and pains" of aging. That's
why spinal fractures are often undiagnosed.
- Loss
of height: Loss of height is one of
the signs that multiple fractures of the spine
have occurred. When asked how tall they are, most
women recite their "known" height, despite
the fact that they haven't had an accurate height
measurement in years. It's normal to lose a little
height as you age due to flattening of the discs
between the vertebrae; however, height loss can
also occur when one or more of your vertebrae
fracture. For that reason, it is recommended that
all women have their height measured at least
once a year.
- Stooped
posture and hunched back (dowager's hump):
This can be caused by multiple fractures to the
upper back that eventually cause the spine and
neck to bend forward. While there is no way that
a person's height can be fully regained or the
spinal column completely straightened, the fracture
pain can be treated and new fractures prevented.
Women
who have advanced osteoporosis can fracture vertebrae
merely by sneezing, coughing, rolling over in bed
or getting in or out of the bath.
Diagnosis
It is very important that spinal fractures are diagnosed
as early as possible so they can be treated appropriately.
Your health care professional will give you a physical
exam and look for any of the above-mentioned symptoms.
An x-ray, and quite possibly a MRI, will be done.
When assessing bone strength before a fracture occurs,
a clinician will refer the patient for a bone density
test or Dual Energy X-Ray Absorptiometry (DXA) scan.
The
National Osteoporosis Foundation recommends bone density
testing for the following individuals:
- All
women age 65 and older, regardless of risk factors
for osteoporosis
- Younger
postmenopausal women with one or more risk factors
(besides Caucasian race, female gender and postmenopausal
status)
- All
postmenopausal women who have had any type of
fracture (this is to confirm a diagnosis of osteoporosis
and to determine its severity)
- Women
with low levels of estrogen who are at clinical
risk for osteoporosis
- People
with spinal deformities
- People
on or about to be on long-term steroid therapy
- People
with primary hyperparathyroidism
- People
being monitored to assess response to an approved
osteoporosis medication
Treatment
Spinal fractures can be treated in a number of ways,
depending on the seriousness and the cause of the
break. For spinal fractures caused by osteoporosis
(the majority of cases), treatment usually focuses
on alleviating pain and managing the underlying disease.
Once the fracture has been treated, it's important to keep bones healthy and to avoid future fracture. This includes calcium supplements; weight-bearing and resistance exercise to build bone mass, and learning to prevent falls. There are several classes of medication approved for treatment of osteoporosis. These include bisphosphonates, estrogen/hormone therapy and selective estrogen receptor modulators. (see the "Tips
for Keeping Your Bones Fracture Free" section
of this Tool Kit).
Spinal
fractures may also be treated with a procedure called
balloon kyphoplasty. This minimally invasive procedure
can stabilize and repair fractured vertebrae. Under
x-ray guidance, a small needle is inserted into the
compressed vertebra and a balloon is directed into
the bone through this needle. The balloon is then
inflated, recreating the natural shape and height
of the bone. When the balloon is deflated and removed,
bone cement is injected into the newly created cavity
and an internal cast is formed. Although the complication
rate with balloon kyphoplasty has been demonstrated
to be low, as with most surgical procedures, there
are associated risks, including serious complications.
Be sure to consult your physician for a full discussion
of risks.
References
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