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Vertebral Compression Fractures

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Part of the book series: Aging Medicine ((AGME))

Abstract

Vertebral compression fractures (VCFs) are the most common ­fragility fractures that affect the elderly population accounting for over 70,000 hospital admissions annually in the United States. Osteoporosis is a significant risk factor for VCFs which affects white females at a disproportionately greater rate than any other demographic group. Quantitative microarchitectural changes in the cancellous and cortical bone in the vertebral body result in qualitative changes to the vertebral endplate biomechanical properties leading to failure of the anterior column and subsequent compression fractures. While the majority of fractures are asymptomatic, pain with routine activities is a common presenting symptom. Non-steroidal medications, bracing, and low-dose narcotic medications are usually effective in treating most patients who have symptomatic VCFs. Percutaneous injection of polymethylmethacrylate has shown some promise in relieving pain from VCF, although recent studies have questioned these findings. Preventative care with ­vitamin D, calcium supplementation, and bone mineral density studies can significantly decrease the risk of developing osteoporosis and subsequently VCFs.

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References

  1. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761–1767.

    Article  PubMed  Google Scholar 

  2. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ, 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res. 1992;7(2):221–227.

    Article  CAS  PubMed  Google Scholar 

  3. Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J. 2006;6(5):479–487.

    Article  PubMed  Google Scholar 

  4. Melton LJ, 3rd. Epidemiology of spinal osteoporosis. Spine (Phila Pa 1976). 1997;22(24 Suppl):2S–11S.

    Google Scholar 

  5. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone. 2003;32(1):78–85.

    Article  CAS  PubMed  Google Scholar 

  6. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114(11):919–923.

    CAS  PubMed  Google Scholar 

  7. White AAI, Panjabi MM. Physical properties and functional biomechanics of the spine. In: White AAI, Panjabi MM (eds) Clinical Biomechanics of the Spine, 2nd ed. Philadelphia: Lippincott; 1990:28–45.

    Google Scholar 

  8. Myers ER, Wilson SE. Biomechanics of osteoporosis and vertebral fracture. Spine (Phila Pa 1976). 1997;22(24 Suppl):25S–31S.

    CAS  Google Scholar 

  9. Hayes WC, Piazza SJ, Zysset PK. Biomechanics of fracture risk prediction of the hip and spine by quantitative computed tomography. Radiol Clin North Am. 1991;29(1):1–18.

    CAS  PubMed  Google Scholar 

  10. Lunt M, O’Neill TW, Felsenberg D, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone. 2003;33(4):505–513.

    Article  PubMed  Google Scholar 

  11. Briggs AM, Greig AM, Wark JD. The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int. 2007;18(5):575–584.

    Article  CAS  PubMed  Google Scholar 

  12. Ciarelli TE, Fyhrie DP, Parfitt AM. Effects of vertebral bone fragility and bone formation rate on the mineralization levels of cancellous bone from white females. Bone. 2003;32(3):311–315.

    Article  CAS  PubMed  Google Scholar 

  13. Gilsanz V, Loro ML, Roe TF, Sayre J, Gilsanz R, Schulz EE. Vertebral size in elderly women with osteoporosis. Mechanical implications and relationship to fractures. J Clin Invest. 1995;95(5):2332–2337.

    Article  CAS  PubMed  Google Scholar 

  14. Tveit P, Daggfeldt K, Hetland S, Thorstensson A. Erector spinae lever arm length variations with changes in spinal curvature. Spine (Phila Pa 1976). 1994;19(2):199–204.

    CAS  Google Scholar 

  15. Pollintine P, Dolan P, Tobias JH, Adams MA. Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine (Phila Pa 1976). 2004;29(7):774–782.

    Google Scholar 

  16. Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P. Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res. 2006;21(9):1409–1416.

    Article  PubMed  Google Scholar 

  17. Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res. 2007;22(3):425–433.

    Article  PubMed  Google Scholar 

  18. Glaser DL, Kaplan FS. Osteoporosis. Definition and clinical presentation. Spine (Phila Pa 1976). 1997;22(24 Suppl):12S–16S.

    CAS  Google Scholar 

  19. Francis RM, Baillie SP, Chuck AJ, et al. Acute and long-term management of patients with vertebral fractures. Q J Med. 2004;97(2):63–74.

    CAS  Google Scholar 

  20. Genant HK, Jergas M. Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int. 2003;14(Suppl 3):S43–S55.

    PubMed  Google Scholar 

  21. Bauer JS, Muller D, Ambekar A, et al. Detection of osteoporotic vertebral fractures using multidetector CT. Osteoporos Int. 2006;17(4):608–615.

    Article  CAS  PubMed  Google Scholar 

  22. Maksymowych WP. Managing acute osteoporotic vertebral fractures with calcitonin. Can Fam Physician. 1998;44:2160–2166.

    CAS  PubMed  Google Scholar 

  23. Lyritis GP, Tsakalakos N, Magiasis B, Karachalios T, Yiatzides A, Tsekoura M. Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-­controlled clinical study. Calcif Tissue Int. 1991;49(6):369–372.

    Article  CAS  PubMed  Google Scholar 

  24. Storm T, Thamsborg G, Steiniche T, Genant HK, Sorensen OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med. 1990;322(18):1265–1271.

    Article  CAS  PubMed  Google Scholar 

  25. Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 1995;333(22):1437–1443.

    Article  CAS  PubMed  Google Scholar 

  26. Hochberg MC, Thompson DE, Black DM, et al. Effect of alendronate on the age-specific incidence of symptomatic osteoporotic fractures. J Bone Miner Res. 2005;20(6):971–976.

    Article  CAS  PubMed  Google Scholar 

  27. Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11(1):83–91.

    Article  CAS  PubMed  Google Scholar 

  28. Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA. 1999;281(23):2189–2197.

    Article  CAS  PubMed  Google Scholar 

  29. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434–1441.

    Article  CAS  PubMed  Google Scholar 

  30. Lippuner K. Medical treatment of vertebral osteoporosis. Eur Spine J. 2003;12 Suppl 2:S132–141.

    Article  PubMed  Google Scholar 

  31. Shen M, Kim Y. Osteoporotic vertebral compression fractures: a review of current surgical management techniques. Am J Orthop (Belle Mead NJ). 2007;36(5):241–248.

    Google Scholar 

  32. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J. 2008;8(3):488–497.

    Article  PubMed  Google Scholar 

  33. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18(10):1897–1904.

    CAS  PubMed  Google Scholar 

  34. Martin JB, Jean B, Sugiu K, et al. Vertebroplasty: clinical experience and follow-up results. Bone. 1999;25(2 Suppl):11S–15S.

    Article  CAS  PubMed  Google Scholar 

  35. Layton KF, Thielen KR, Koch CA, et al. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol. 2007;28(4):683–689.

    CAS  PubMed  Google Scholar 

  36. Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998;36(3):533–546.

    Article  CAS  PubMed  Google Scholar 

  37. Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for ­painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557–568.

    Article  CAS  PubMed  Google Scholar 

  38. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for ­osteoporotic spinal fractures. N Engl J Med. 2009;361(6):569–579.

    Article  CAS  PubMed  Google Scholar 

  39. Rousing R, Hansen KL, Andersen MO, Jespersen SM, Thomsen K, Lauritsen JM. Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine (Phila Pa 1976). 2010;35(5):478–482.

    Google Scholar 

  40. Bono CM, Heggeness M, Mick C, Resnick D, Watters WC, 3rd. North American Spine Society: Newly released vertebroplasty randomized controlled trials: a tale of two trials. Spine J. 2010;10(3):238–240.

    Article  PubMed  Google Scholar 

  41. Bolster MB. Consternation and questions about two vertebroplasty trials. Cleve Clin J Med. 2010;77(1):12–16.

    Article  PubMed  Google Scholar 

  42. Orr RD. Vertebroplasty, cognitive dissonance, and evidence-based medicine: what do we do when the ‘evidence’ says we are wrong? Cleve Clin J Med. 2010;77(1):8–11.

    Article  PubMed  Google Scholar 

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Correspondence to Nader M. Hebela .

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Ughwanogho, E., Hebela, N.M. (2011). Vertebral Compression Fractures. In: Pignolo, R., Keenan, M., Hebela, N. (eds) Fractures in the Elderly. Aging Medicine. Humana Press. https://doi.org/10.1007/978-1-60327-467-8_11

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  • DOI: https://doi.org/10.1007/978-1-60327-467-8_11

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  • Print ISBN: 978-1-60327-466-1

  • Online ISBN: 978-1-60327-467-8

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