By Atiq Rehman, M.D., Interventional Pain Physician, Millennium Pain Center
Osteoporosis is a disease that thins and weakens the bones to the point that they become fragile and break easily. Women and men with osteoporosis most often break bones in the hip, spine, and wrist. There are no symptoms of osteoporosis until a fracture occurs.
- Osteoporosis is a major public health threat for 44 million Americans, 68 percent of whom are women.
- In the U.S. today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at increased risk for this disease.
- One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in their lifetime.
- Osteoporosis can strike at any age.
- Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites.
- Based on figures from hospitals and nursing homes, the estimated national direct expenditures for osteoporosis and related fractures total $14 billion each year.
Certain factors can put you at risk for developing osteoporosis, but there are also steps you can take to prevent it. Although there is no cure for osteoporosis, it can be treated. If your doctor does not specialize in osteoporosis, he or she can refer you to a specialist. There is not one type of doctor who cares for people with osteoporosis.
What is a compression fracture?
The most common type of fracture seen in osteoporosis is of the spine, a vertebral compression fracture (VCF), in which the vertebral bone collapses onto itself. The severe pain caused by VCF is typically exacerbated while weight-bearing and, if not treated, leads to chronic pain.
- Prevalence of VCFs increases with age, reaching 40 percent in 80-year-old women.
- Each VCF increases the chance of another VCF to 19.2 percent within a year, and two VCFs increase it to 24 percent.
- Over 50 percent of those with one or two VCF require self-care assistance, which is significantly higher compared to eight percent of osteoarthritis patients suffering from low-back pain.
What complications can occur after a compression fracture?
Most of the complications arising after a compression fracture are a direct consequence of severe pain and resultant immobility from the fracture.
- Chronic pain itself is associated with a high incidence of depression and/or anxiety.
- Opioids prescribed for treatment of pain in addition to immobility may cause lack of appetite, nausea, and constipation.
- Every VCF reduces the forced vital capacity (ability to take a deep breath) by nine percent, leading to increased risk of developing a collapsed lung (atelectasis) and pneumonia.
- Immobility can lead to worsening of osteoporosis and one to three percent muscle wasting per day.
- Immobility can further cause decubitus ulcers and risk of deep vein thrombosis (blood clot in leg) and subsequent pulmonary embolism.
- Women with clinically diagnosed VCFs have a 15 percent higher mortality rate and are two to three times more likely to die of pulmonary causes.
The morbidity and mortality associated with osteoporotic vertebral fractures demands the need for more aggressive treatment. Therefore, vertebral augmentation techniques like vertebroplasty have emerged as a viable treatment option, resulting in rapid pain relief and improved mobility.
Treatment of compression fractures: vertebroplasty
Vertebroplasty involves use of acrylic bone cement to stabilize and treat painful vertebral compression fractures. It is performed by the injection of cement into a fractured vertebral body via a needle that is placed through the skin under image guidance (X-ray or CT). It is typically performed under mild sedation and does not require general anesthesia or a breathing tube. It is usually performed in the office or as an outpatient procedure, and does not require an overnight stay.
Since the site of the procedure is very close to the spinal cord, it is critical that the procedure is performed by expert physicians, like interventional pain physicians. These experts are trained not only to perform the procedure, but also to handle any complications that may occur. Most of the complications are minor and self-limiting, but serious complications can happen in less than one percent of cases. Interventional pain physicians who are experts in performing vertebroplasty will often serve as faculty in teaching and training of other physicians to perform vertebroplasty, and may be authors of numerous articles on this subject in respected medical journals.
Vertebroplasty has been performed in hundreds of thousands of patients and, if appropriately indicated, may result in almost complete pain relief, with resumption of daily living in 80 to 85 percent of the cases.
If you or a loved one is suffering from a compression fracture of the spine, talk to your doctor to find out if vertebroplasty is an option for you.
For more information, you may contact Millennium Pain Center at 309-662-4321. It is located at 1015 S. Mercer Ave in Bloomington. Information is also available online at www.millenniumpaincenter.com. For more information on osteoporosis or to schedule a bone density screening, you may contact The Bone Health Clinic at Millennium Pain Center, 309-662-4321. Shannon Laesch and Elizabeth Madlem are certified bone health consultants. The clinic provides screening, diagnosis, and a comprehensive treatment plan for people who have or are at risk of developing osteoporosis.
Photo credit: KatarzynaBialasiewicz/iStock