Osteoporotic Vertebral Fractures
Original Editor - Your name will be added here if you created the original content for this page.
Top Contributors - Mathieu Vanderroost, Angeliki Chorti, Lucinda hampton, Jasper Vermeersch, Jon Room, Kim Jackson, Jelle Van Hemelryck, Khloud Shreif, Laura Ritchie, Vidya Acharya, Lauren Lopez, 127.0.0.1, Admin, Rachael Lowe, Kai A. Sigel, WikiSysop and Claire Knott
Search Strategy[edit | edit source]
Databases: Pubmed, Web of Science, Pedro.
As subject headings varied between the databases, various combinations of the key words were used. These were the most productive: Osteoporotic Vertebral Fractures, Osteoporotic Vertebrae Fractures, Insufficiency Fractures, Vertebral Compression Fractures, Osteoporosis AND physical therapy, Osteoporosis AND diagnosis, Osteoporotic Vertebral Fractures AND treatment.
Definition / Description[edit | edit source]
Osteoporotic (fragility) fractures are fractures that result from mechanical forces that would not ordinarily result in a fracture, known as low-level (or low-energy) trauma according to National Institute for Health and Care Excellence (NICE) clinical guidelines. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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] One of the significant consequences of osteoporosis is fractures. Common types of fracture include wrist fractures, hip fractures and vertebral fractures.[1][4]
Osteoporosis in older adults is caused by an imbalance of bone resorption in excess of bone formation. The dominant factor leading to bone loss in older adults appears to be gonadal sex steroid deficiency, with multiple genetic and biochemical factors, such as Vitamin D Deficiency or hyperparathyroidism, that may accelerate bone loss.
Conditions that adversely affect growth and development may limit development of peak bone mass and accelerate subsequent bone loss. Studies of bone microarchitecture have shown that trabecular bone loss begins in the third decade of life, before gonadal sex steroid deficiency develops, whereas cortical loss typically begins in the sixth decade, about the time of menopause in women and about the same age in men.
Antiresorptive agents for the treatment of osteoporosis act primarily by limiting osteoclast activity, whereas osteoanabolic agents, such as teriparatide, act primarily by stimulating osteoblastic bone formation. Clinical investigation of new compounds for the treatment of osteoporosis is mainly directed to those that stimulate bone formation or differentially decrease bone resorption more than bone formation. Therapies for osteoporosis are associated with adverse effects, but in patients at high risk of fracture, the benefits generally far outweigh the risks.
Important: Bone mass alone does not explain the risk of fractures in at least 50% of osteoporosis cases; bone quality also plays a role. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy[edit | edit source]
Epidemiology / Etiology[edit | edit source]
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.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In America 700,000 vertebral fractures occur within the population who have osteoporosis.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title In addition to this once a vertebral fracture has been sustained the risk of subsequent vertebral, hip or wrist fractures increase. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Characteristics / Clinical Presentation[edit | edit source]
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][5] in addition to vertebral fractures being linked to mortality.[6]
Differential Diagnosis[edit | edit source]
Diagnostic Procedures[edit | edit source]
Outcome Measures[edit | edit source]
Examination[edit | edit source]
Medical Management[edit | edit source]
Treatment after vertebral fracture should include appropriate pain management and possibly bracing.[7]
Vertebral fractures can also be treated surgically using vertebroplasty and kyphoplasty.[8][9]
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.
Physical Therapy Management[edit | edit source]
Regarding Physiotherapy management, there are a number of treatment approaches, including strengthening exercise, stabilisation exercise, balance training, stretching, relaxation techniques, manual therapy and taping.[10][11] Currently a large RCT is comparing exercise based and ‘hands on’ manual therapy based physiotherapy against a control.[11]
Key Research[edit | edit source]
Resources[edit | edit source]
Clinical Bottom Line[edit | edit source]
Recent Related Research[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 NICE. Osteoporosis: assessing the risk of fragility fracture: NICE Guidelines CG146. Manchester: National Institute for Health and Care Excellence, 2012.
- ↑ NOS. What is Osteoporosis? National Osteoporosis Society. https://www.nos.org.uk/about-osteoporosis (accessed 03/02/15)
- ↑ 3.0 3.1 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
- ↑ NHS. Osteoporosis. National Health Service. http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx (accessed 03/02/15)
- ↑ NOF. Osteoporosis and your spine. National Osteoporosis Foundation. http://nof.org/articles/18 (accessed 03/02/15)
- ↑ 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
- ↑ Gerdhem P. Osteoporosis and fragility fractures: Vertebral fractures. Best Practice &amp;amp;amp;amp;amp;amp;amp; Research Clinical Rheumatology 2013 27: 743–755
- ↑ Dionyssiotis Y. Management of osteoporotic vertebral fractures. Int J Gen Med. 2010 3: 167–171.
- ↑ 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
- ↑ Pratelli E, Cinotti I, Pasquetti P. Rehabilitation in osteoporotic vertebral fractures. Clin Cases Miner Bone Metab. 2010 7(1): 45–47.
- ↑ 11.0 11.1 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
