Osteoporosis and Spinal Compression Fractures

by Justin D. Dumont, D.O., MS

Osteoporosis and Spinal Compression Fractures

Osteoporosis is a disease where you have thin, weak bones that are more likely to break. It’s the most common metabolic bone condition worldwide and currently affects about 10 million Americans, with the total number affected expected to increase to 15 million in the next couple of years. Low bone density in general, which also increases fracture risk, affects about 54 million Americans. Around two million broken bones a year are directly related to osteoporosis.

  • In patients 45 years old or older, around 70% of fractures are related to osteoporosis.
  • About 50% of people over 75 years old will be affected by osteoporosis.
  • Osteoporosis tends to affect women more than men.
  • Around 40% of women have a lifetime risk of fracture due to osteoporosis.

Osteoporosis is often a “silent” disease, where people don’t know they have it until they have a fracture. The places on the body most likely to fracture due to osteoporosis are the spine, the hips, and the wrists.

Why does osteoporosis develop?

As children, our bones are maturing and developing. Our bones reach peak bone density between the ages of 18-25. After age 25, our bone density begins to decrease. In women, hormonal changes due to menopause can significantly decrease bone density. Some women may lose up to 20% of their bone density within 5-7 years of menopause. Some other medical conditions or medications may contribute to low bone density and osteoporosis. Talk to your primary care doctor if you’re worried about your specific condition.

Lifestyle factors such as smoking and excessive drinking can contribute to osteoporosis.

How can I prevent osteoporosis?

Prevention is extremely important. The more bone density you have when you’re young, especially in that 18–25-year-old range, the more you can help prevent osteoporosis.

A healthy diet and weight-bearing exercise (especially exercises that put stress on bone) help promote bone density. Avoid things that are known to possibly impact bone health, like smoking and excessive drinking.

While starting early to promote bone density is best, maintaining good habits is important even after your bones have reached maximum density. Women over the age of 65 and men over the age of 70 should be screened for osteoporosis by their primary care doctor. Oftentimes a Dexa scan, a type of scan that measures bone density, can be done to see if you have osteoporosis. You may also have lab work done, and your doctor may recommend some medications and supplements. If you have certain medical conditions or a family history of problems with osteoporosis, you may be screened earlier. Your primary care doctor can give you more details about your specific situation.

What is a spinal compression fracture?

Spinal compression fractures are breaks that occur in the vertebrae of the spine, usually due to osteoporosis. The spine has three main sections: the cervical spine, at the top; the thoracic spine, in the middle; and the lumbar spine, at the base. Compression fractures occur most commonly within in the thoracic spine, but also occur in the lumbar spine. They occur in areas where there are transitions between different shapes of vertebra.

In a compression fracture, the vertebral bone becomes compressed. The shape of the bone can change due to the compression. These fractures can be very painful and very debilitating. The pain can be very severe, and the pain can wrap around the chest if the fracture is in the thoracic spine. There may also be pain down the middle of your back.

How does a spinal compression fracture occur?

Many of these fractures occur due to daily activities, such as laughing, coughing, sneezing, etc. You don’t have to have a fall or a visible injury in order to get a spinal compression fracture. The bone density is so low due to the osteoporosis that any activity can cause the fracture. That’s why prevention is so important.

What should I do if I develop a spinal fracture?

Since the fractures are so painful, patients who have them often go to the emergency room or an urgent care to be seen. Treatment starts with an x-ray or CT scan to see the fracture, and they’re often referred to a specialist.

Historically the standard of care for a compression fracture includes wearing a brace to help immobilize and try to prevent movement of the spine, taking pain medications, and resting. Unfortunately, some people are still in pain with this treatment. Happily, procedures have been developed that can help treat not only the pain but also help to stabilize the fracture.

The main surgical treatment is a minimally invasive procedure called kyphoplasty. It can be done in a surgery center or operating room. In this surgery, the patient is on their stomach and their skin is numbed. Using an X-ray camera called a fluoroscope to see underneath the skin, the physician inserts small needles into the bone. A balloon is sent through the needle into the bone and inflated to help increase some of the height that may have been lost due to the compression. Cement is then added into the bone to help stabilize the fracture and keep the bone at the expanded height.

Kyphoplasty is one of the procedures that I find most rewarding because it can be a wonderful solution for patients with severe pain and can help reduce their risk of mortality. There are more than 50 studies showing kyphoplasty as the standard of care for treatment of the pain and reduction of mortality.

Why is treatment important?

Compression fractures of the spine can become very painful, and folks oftentimes have to modify their lifestyles because they're unable to do their activities of daily living. The pain may be so severe that bed rest is the best treatment option. This pain may start a negative cycle in patients: pain causes decreased mobility, which leads to immobility, which leads to weight loss from lack of appetite and medications. The patients may then be isolated because they’re stuck at home and become depressed. With

kyphoplasty we can stop this vicious cycle and help to restore some of the quality of life and function back to our patients.

I had a patient who was very active with many hobbies, and unfortunately developed a few fractures due to osteoporosis in the spine. Initially, they were hesitant about pursuing kyphoplasty and attempted conservative treatment for a few weeks. During that time their pain continued to get worse, and they had challenges with wearing the brace and tolerating medication side effects. They began to lose weight and started to feel isolated. We spoke, and they decided to go ahead with the kyphoplasty. I saw them recently at their six-month follow-up and they’ve done exceedingly well – they gained the weight back and are involved again in community activities, spending time with their grandchildren and involved in their church. For me it’s extremely rewarding because I can help someone to regain their quality of life.

Frequently asked questions

What is the difference between bone fusions and kyphoplasty?

Kyphoplasty stabilizes each bone individually by going into the bone itself, as a treatment for spinal compression fractures. Bone fusions connect multiple bones together and are used to treat other conditions.

Does arthritis in the spine increase your risk for a spinal fracture?

It may slightly, depending on the specifics of your arthritis, but osteoporosis is a much more common cause.

What is the difference between osteopenia, osteoporosis and osteoarthritis?

Osteopenia and osteoporosis both deal with bones becoming thinner and weaker. Osteopenia happens first, and if the bone gets weaker it can progress to osteoporosis. Osteoporosis is bone that meets the criteria for being a certain level below the normal bone density. Osteoarthritis is “wear and tear” arthritis that is usually a result of aging and is seen in worn-out joints.

What is the difference between bone density and bone strength?

Bone density is the actual measurement of how dense a bone is. Bone strength is a byproduct of how dense the bone is. Low bone density leads to low bone strength and an increased risk of fracture.

Can fractures cause a loss in height?

Yes. As the height of a vertebra decreases due to a compression fracture, shrinking is not uncommon. Osteoporosis in the spine can also cause people to bend forward, causing further loss of height.

What should I be avoiding if I have a fracture?

Avoid excessive bending forward and avoid twisting. Bracing can help as a reminder to stand up straight. After kyphoplasty I recommend physical therapy. Before you have the procedure, you may have developed some coping mechanisms to avoid pain, where you don’t stand or walk quite normally. The physical therapist can help you work on your posture and your gait and restore them as much as possible.