Osteoporotic Vertebral Fractures: Difference between revisions

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[[Image:Vertebral Fracture.png|right|250x350px|Vertebral Fracture]]  
[[Image:Vertebral Fracture.png|right|250x350px|Vertebral Fracture]]  
<div><br>Osteoporotic vertebral fractures are a significant problem. The number of vertebral fractures in the UK in 2010 was estima<span style="line-height: 1.5em; font-size: 13.2799997329712px;">ted to be 30,994, this number is expected to increase by 17.9% by 2020.</span><ref name="Gauthier et al (2011)">Gauthier A, Kanis JA, Jiang Y, Martin M, Compston JE, Borgström F, Cooper C, McCloskey EV. Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos 2011 6:179–188 DOI 10.1007/s11657-011-0063-y</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;In America 700,000 vertebral fractures occur within the population who have osteoporosis.</span><ref name="Kim and Vaccaro (2006)">Kim DH, Vaccaro AR. Contemporary Concepts in Spine Care: Osteoporotic compression fractures of the spine; current options and considerations for treatment. The Spine Journal. 2006 6 479–487</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;The lifetime risk of a vertebral fracture in women over 50 is estimated to be one in three, in addition to this once a vertebral fracture has been sustained her risk of subsequent vertebral, hip or wrist fractures increase.</span><ref name="NICE 2011">NICE. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended): NICE technology appraisal guidance 160. Manchester: National Institute for Health and Care Excellence, 2011</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;Symptoms of vertebral fracture can include pain, curvature of the spine, height loss, difficulties with ADLs, loss of self-esteem related to changes in body shape, and in cases of severe kyphosis respiratory and gastrointestinal problems,</span><ref name="Strom et al (2011)" /><ref name="NOF (no date)">NOF. Osteoporosis and your spine. National Osteoporosis Foundation. http://nof.org/articles/18 (accessed 03/02/15)</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;in addition to vertebral fractures being linked to mortality.</span><ref name="Puisto et al (2011)">Puisto V, Rissanen H, Heliövaara M, Impivaara O, Jalanko T, Kröger H, Knekt P, Aromaa A, Helenius I. Vertebral fracture and cause-specific mortality: a prospective population study of 3,210 men and 3,730 women with 30 years of follow-up. Eur Spine J 2011 20:2181–2186 DOI 10.1007/s00586-011-1852-0</ref></div> </div>  
<div><br>Osteoporotic vertebral fractures are a significant problem. The number of vertebral fractures in the UK in 2010 was estima<span style="line-height: 1.5em; font-size: 13.2799997329712px;">ted to be 30,994, this number is expected to increase by 17.9% by 2020.</span><ref name="Gauthier et al (2011)">Gauthier A, Kanis JA, Jiang Y, Martin M, Compston JE, Borgström F, Cooper C, McCloskey EV. Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos 2011 6:179–188 DOI 10.1007/s11657-011-0063-y</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;In America 700,000 vertebral fractures occur within the population who have osteoporosis.</span><ref name="Kim and Vaccaro (2006)">Kim DH, Vaccaro AR. Contemporary Concepts in Spine Care: Osteoporotic compression fractures of the spine; current options and considerations for treatment. The Spine Journal. 2006 6 479–487</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;The lifetime risk of a vertebral fracture in women over 50 is estimated to be one in three, in addition to this once a vertebral fracture has been sustained the risk of subsequent vertebral, hip or wrist fractures increase.</span><ref name="NICE 2011">NICE. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended): NICE technology appraisal guidance 160. Manchester: National Institute for Health and Care Excellence, 2011</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;Symptoms of vertebral fracture can include pain, curvature of the spine, height loss, difficulties with ADLs, loss of self-esteem related to changes in body shape, and in cases of severe kyphosis respiratory and gastrointestinal problems,</span><ref name="Strom et al (2011)" /><ref name="NOF (no date)">NOF. Osteoporosis and your spine. National Osteoporosis Foundation. http://nof.org/articles/18 (accessed 03/02/15)</ref><span style="line-height: 1.5em; font-size: 13.2799997329712px;">&nbsp;in addition to vertebral fractures being linked to mortality.</span><ref name="Puisto et al (2011)">Puisto V, Rissanen H, Heliövaara M, Impivaara O, Jalanko T, Kröger H, Knekt P, Aromaa A, Helenius I. Vertebral fracture and cause-specific mortality: a prospective population study of 3,210 men and 3,730 women with 30 years of follow-up. Eur Spine J 2011 20:2181–2186 DOI 10.1007/s00586-011-1852-0</ref></div></div>
 
== Treatment  ==
== Treatment  ==


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Osteoporotic Vertebral fractures[edit | edit source]

Osteoporosis is a disease that is characterised by low bone mass,[1] causing bones to be more fragile and likely to fracture.[2] The word osteoporosis literally means porous bone.[3] More can be found out about osteoporosis at http://www.physio-pedia.com/Osteoporosis. One of the significant consequences of osteoporosis is fractures, it is estimated that worldwide an osteoporotic fracture will be experienced by one in three women and one in five men.[3] Common types of fracture include wrist fractures, hip fractures and vertebral fractures.[1][4]

Vertebral Fracture

Osteoporotic vertebral fractures are a significant problem. The number of vertebral fractures in the UK in 2010 was estimated to be 30,994, this number is expected to increase by 17.9% by 2020.[5] In America 700,000 vertebral fractures occur within the population who have osteoporosis.[6] The lifetime risk of a vertebral fracture in women over 50 is estimated to be one in three, in addition to this once a vertebral fracture has been sustained the risk of subsequent vertebral, hip or wrist fractures increase.[7] Symptoms of vertebral fracture can include pain, curvature of the spine, height loss, difficulties with ADLs, loss of self-esteem related to changes in body shape, and in cases of severe kyphosis respiratory and gastrointestinal problems,[3][8] in addition to vertebral fractures being linked to mortality.[9]

Treatment[edit | edit source]

Treatment after vertebral fracture should include appropriate pain management and possibly bracing.[10] Vertebral fractures can be treated surgically using vertebroplasty and kyphoplasty.[11][12] In a vertebroplasty bone cement, usually polymethylmethacrylate (PMMA), is injected into the vertebral bone. In a kyphoplasty a balloon is inserted into the vertebral body, the balloon is inflated to attempt to re-establish normal height and posture, the balloon is remove and cement injected. NICE[12] recommends these treatments when following vertebral fracture, people have severe pain despite pain management, and when the pain is confirmed as being at the same level as the fracture. Regarding Physiotherapy management, there are a number of treatment approaches, including strengthening exercise, stabilisation exercise, balance training, stretching, relaxation techniques, manual therapy and taping.[13][14] Currently a large RCT is comparing exercise based and ‘hands on’ manual therapy based physiotherapy against a control.[14]

References[edit | edit source]

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  1. ↑ 1.0 1.1 NICE. Osteoporosis: assessing the risk of fragility fracture: NICE Guidelines CG146. Manchester: National Institute for Health and Care Excellence, 2012.
  2. ↑ NOS. What is Osteoporosis? National Osteoporosis Society. https://www.nos.org.uk/about-osteoporosis (accessed 03/02/15)
  3. ↑ 3.0 3.1 3.2 Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jönsson B. Osteoporosis: burden, health care provision and opportunities in the EU: A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2011 6:59–155 DOI 10.1007/s11657-011-0060-1
  4. ↑ NHS. Osteoporosis. National Health Service. http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx (accessed 03/02/15)
  5. ↑ Gauthier A, Kanis JA, Jiang Y, Martin M, Compston JE, Borgström F, Cooper C, McCloskey EV. Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos 2011 6:179–188 DOI 10.1007/s11657-011-0063-y
  6. ↑ Kim DH, Vaccaro AR. Contemporary Concepts in Spine Care: Osteoporotic compression fractures of the spine; current options and considerations for treatment. The Spine Journal. 2006 6 479–487
  7. ↑ NICE. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended): NICE technology appraisal guidance 160. Manchester: National Institute for Health and Care Excellence, 2011
  8. ↑ NOF. Osteoporosis and your spine. National Osteoporosis Foundation. http://nof.org/articles/18 (accessed 03/02/15)
  9. ↑ Puisto V, Rissanen H, Heliövaara M, Impivaara O, Jalanko T, Kröger H, Knekt P, Aromaa A, Helenius I. Vertebral fracture and cause-specific mortality: a prospective population study of 3,210 men and 3,730 women with 30 years of follow-up. Eur Spine J 2011 20:2181–2186 DOI 10.1007/s00586-011-1852-0
  10. ↑ Gerdhem P. Osteoporosis and fragility fractures: Vertebral fractures. Best Practice &amp;amp;amp;amp; Research Clinical Rheumatology 2013 27: 743–755
  11. ↑ Dionyssiotis Y. Management of osteoporotic vertebral fractures. Int J Gen Med. 2010 3: 167–171.
  12. ↑ 12.0 12.1 NICE. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures: NICE technology appraisal guidance TA279. Manchester: National Institute for Health and Care Excellence, 2013
  13. ↑ Pratelli E, Cinotti I, Pasquetti P. Rehabilitation in osteoporotic vertebral fractures. Clin Cases Miner Bone Metab. 2010 7(1): 45–47.
  14. ↑ 14.0 14.1 Barker K, Javaid MK, Newman M, Minns Lowe C, Stallard N, Campbell H, Gandhi V, Lamb S. Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial. Trials 2014 15:22
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