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About 700,000 cases of compression fracture due to osteoporosis occur yearly in the United States. In this article, we will take a close look at this common fracture - which causes the bones - vertebrae - to collapse in height.

 

ANATOMY

The human spine consists of 24 bones called vertebrae. They are built just like a square egg - outer shell (cortex) and an inner yolk portion - the medullary cavity. Compression fractures cause the outer shell to collapse. A simple compression fracture involves the vertebral body only however the spinal cord is at risk with severe fractures because of its proximity to the posterior part of the vertebral body.

 

CAUSES

An injury, such as a fall on the buttocks or a car accident where the person’s head hits the steering wheel (restrained by the seat belt) can cause a vertebra to fracture. Compression fractures occur when the forces are too great for the spine to withstand or the bones of the spine are weakened (osteoporosis).

 

Fractures from osteoporosis usually occur in the front part (anterior) portion of the vertebra.
The worse the osteoporosis, the less trauma will be required for a compression fracture to occur.

 

SYMPTOMS

What does the patient feel ? Symptoms may include immediate and sharp back pain, decreased range of motion, and reduced sensation to the lower limbs if severe.

 

DIAGNOSIS

A doctor of chiropractic will usually perform a complete history and physical examination. Pressure (palpation) over the vertebra or striking the spinous process with a reflex hammer will almost take their breath away. If the doctor feels a compression fracture is present, x-rays will be ordered which can be performed by ACRRT personnel.

Additional imaging such as CT or MRI studies may be required if the compression fracture shows multiple small fragments or if there is possible spinal cord involvement.
SURGERY

 

VERTEBROPLASTY

A surgeon uses a needle guided by a special x-ray TV (fluoroscope) to fill the compressed vertebra with bone cement. A reaction in the cement causes it to harden quickly. Approximately 80% of patients feel almost immediate pain relief from this procedure.

 

KYPHOPLASTY

Two long needles are inserted along side of the vertebra. Two holes are drilled into the sides of the vertebra. The surgeon then slides a hollow tube with a deflated balloon on the end through each drill hole. Inflating the balloons restores the height of the vertebra. Bone cement is injected into the hollow space formed by the balloon. This fixes the bone in its proper size and position.

 

OSTEOPOROSIS PREVENTION

I have been performing peripheral DXA bone scans for 6 years on DC’s, their patients, and health store patrons in the Midwest. Generally, 47% of the women and 72% of the men have low scores on their bone scans. I am fond of saying, “Osteoporosis is NOT caused from a deficiency of biphosphonates” rather a lack of proper nutrition especially minerals i.e., calcium, magnesium, and other nutrients including vitamins D3 and K2.

A daily vitamin mixture that provides calcium (1200 mgs), magnesium (500 mgs), and enough vitamin D3 to bring the blood levels to 60+ ng/mls (as much as 10,000 IU’s/day) has been documented to produce higher bone density on follow-up scans.

Calcium alone or only with vitamin D may not be sufficient. Sunlight helps create vitamin D when it strikes a cholesterol molecule. People who live “north” of a line from Atlanta to San Diego will need more sun than others. Twenty minutes daily during the summer may fall far short of what is needed according to recent articles. Imagine how much sun exposure is needed over the winter months!

Exercise is helpful. Young women (30‘s) are osteopenic (birthing 3 children in 5 years) and 70+ year-old men are having compression fractures that needed Vertebro/Kyphoplasty. I diagnosed a 34-year-old (birthing 4 children in 7 years) with a compression fracture.

Good quality x-rays are needed as is careful review of the films. A patient on Fosamax had me examine her cheek and I felt the hole created in her jaw (ONJ) ! No minerals or vitamin D were suggested by her physician when she was given the prescription.

Osteoporosis is wide-spread and I suggest a base-line scan be obtained for many prior to 40 years of age should bone loss be detected. Proper nutrition has been shown to be effective in preventing and reversing the painful and damaging effects of low bone density that has been documented to lead to early death.

In summary:

700, 000 cases of compression fracture/yr in US.
Osteoporotic fractures usually involve anterior part of vertebra.
Radiographs determine severity of compression fracture.
Uncomplicated cases respond well to conservative care. Nutrition should be included.

 


 

References:

  1. About.Com: Orthopedics Sept. 28, 2008
  2. eorthopod.com: Spinal Compression Fractures
  3. wisegeek.com: What is a compression fracture?
  4. spineuniverse: Kyphoplasty and Vertebroplasty: Treatment for Spinal Compression fractures
  5. www.nof.org/osteoporosisdiseasefacts.html: Fast Facts On Osteoporosis

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