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Patient Education: Diseases Conditions Treatments & Procedures

Osteoporosis (Spine)


Primary osteoporosis occurs in individuals when there is no other disease or disorder to account for changes in bone mass. We define osteoporosis when one's bone mass is 67% below age-adjusted average bone mineral density. Peak bone mass occurs in the third decade of life and thereafter bone loss occurs at a rate of 0.3% per year in men and 0.46% per year in women. This increases to 2% to 3% at menopause. It is recommended that you discuss with your primary care physician whether a bone density scan is indicated for you. A complete history including family history and drug history will help make this determination. If indicated your doctor should start you on the appropriate medical management for protecting your bone stock and minimizing your bone loss. Don't forget to exercise, as this is one of the best ways to slow down osteoporosis.

Where does the Orthopaedic Surgeon fit in?

There is increased susceptibility to fracture due to decreased bone mass. Risk of osteoporotic fracture is a continuum with an increased fracture rate as bone mineral density declines. The most common site of fracture is the spine followed by the hip, wrist and pelvis. In your spine, each vertebral body looks like a sponge. In osteoporosis the holes in the sponge get bigger as the amount of solid bone gets thinner and less abundant. I think you can imagine how this change in structure of the vertebrae would cause it to become weaker and be at increased risk of fracture. If you can't imagine this then let us help. Look at these numbers:

Age adjusted prevalence of spine fractures:

% incidence of spine fracture Age
17.6 60-69
27.5 70-79
46.5 80-89
77.8 >90

This presents a significant public health problem particularly as the population ages and the number of baby boomers mature.

Many of these fractures are undetected but are causes of bouts of upper back pain. This usually resolves by six weeks. Over time you may notice you are hunching forward. Well now you know why!(Yes it is true that because of this and that your discs are thinning we do get shorter as we age). But no need to call your tailor yet as your arms and legs do not shrink! Occassionally back pain from osteoporotic fractures does not get better and consultation with a spine surgeon may be indicated.

Surgical Considerations

Surgery is rarely indicated for osteoporotic spine fractures. Screws which are normally used to fix fractures in strong bone have poor grip in osteoporotic bone. Hope is not all lost however thanks to an enterprising French surgeon who filled a vertebrae with bone glue in the early 1980's. This strengthened the bone and relieved pain in his patient. This technique has become known as vertebroplasty and today this technique offers an alternative for osteoporotic compression fractures which remain painful despite appropriate medical management. In the correct patient, vertebroplasty provides rapid pain relief and improves function in elderly patients and reduces hospital stays in many patients.

What is Vertebroplasty?

The name "plasty" is to change, remodel or rebuild. You probably have heard of this with regard to a friend's knee or a relatives hip, knee arthroplasty or hip arthroplasty. Vertebroplasty is to rebuild the vertebrae. Just as our French inventor did 25 years ago we inject bone glue or bone cement into the broken vertebrae and provide it with stability. Pain may be relieved immediately. Your surgeon will need to assess you to determine if you are a good candidate for vertebroplasty because not all osteoporotic compression fractures are the cause of pain. Potential complications exist if done in the wrong patient. Vertebroplasty can be done in the operating room with you awake or asleep. This simple outpatient procedure is now also commonly done in the radiology suite by an experienced interventional radiologist.

Vertebroplasty or Kyphoplasty

A close relative to vertebroplasty is kyphoplasty. Like vertebroplasty, kyphoplasty is used for osteoporotic compression fractures. There are some theoretical advantages to kyphoplasty but the jury is still out on whether the outcome for pain relief is any better. In experienced hands, both techniques are safe and like all things, kyphoplasty has its place and its limitations. Your surgeon will discuss with you whether you are a candidate for one or the other or neither.

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