Nonoperative Treatment Methods for Osteoporotic Compression Fractures

What Are Osteoporotic Compression Fractures?

Osteoporosis is a disease characterized by low bone mass, deterioration of bone tissue leading to bone fragility, and consequent increased fracture risk. It is also responsible for the inadequate accumulation of bone tissue during growth and maturation, excessive bone tissue loss, or both. Due to this, vertebral compression fractures (VCF) are common in osteoporotic individuals. Predominantly it occurs in post-menopausal females. Osteoporosis is of two types:

Primary Osteoporosis: This is the most common osteoporosis and has two types.

1. Type 1: Post-menopausal osteoporosis. It usually occurs in women after 40 years of age.

2. Type 2: Age-associated with osteoporosis. It is also called senile osteoporosis.

Secondary Osteoporosis: In this disease, loss of bone is caused by an identifiable agent or disease process such as an inflammatory disorder, bone marrow disorder, or Corticosteroid use.

What Are the Causes?

• Hyperparathyroidism is an endocrine disorder in which excess parathyroid hormone production leads to high calcium content, ultimately leading to organ dysfunction.

• Excessive thyroid hormone medication.

• Inflammatory disorders are treated with steroids, such as rheumatoid arthritis, lupus, and asthma.

• Long-term use of Corticosteroids.

• Antiseizure medications such as Phenytoin.

• Blood or bone marrow disorders such as myeloma.

• Spinal cord injury with paralysis of the legs.

• Chronic kidney, liver, lung, or gastrointestinal disorders.

What Are the Risk Factors for Osteoporotic Fracture?

• Low calcium intake.

• Recurrent falls.

• Inadequate physical activity.

• Poor health or fragility.

• Old age and those with impaired eyesight.

• Estrogen deficiency (a female sex hormone).

What Are the Symptoms of Compression Fracture?

• It is often associated with pain that may be very mild or extremely painful and needs immediate medical intervention.

• In cases of vertebral compression fractures, there is height loss or a curved spine known as kyphosis. There is acute back pain on bending or lifting. Sudden pain is felt while coughing or sneezing.

• Sleep is disturbed due to pain.

• Patients experience pain while sitting or while trying to stand erect.

• Bowing or bending of the bones.

How Is It Evaluated?

Patients are examined and put through various investigations to confirm the diagnosis. X-ray and MRI (magnetic resonance imaging) are taken to determine the fracture site and extent. Lab tests evaluate complete blood count, liver function test, thyroid-stimulating hormone (TSH), 25-hydroxy vitamin D, and parathyroid hormone levels.

• Dowager’s Hump: It is seen in older women mostly and is caused by osteoporosis. An abnormally curved spine can be seen due to degeneration of the vertebral body in a forward direction. Due to this, the patient complains of loss of height. It can occur even without a fall.

• Supine Sign: The patient finds it difficult to lie flat on the bed with the support of one single pillow for the head, which causes severe pain.

How Can It Be Treated Nonoperatively?

The treatment should be aimed at relieving the pain, restoring normal function, and preventing future fractures. Initially, bed rest is advised but not for so long as it can lead to muscle wasting and soreness. Early mobility up to a tolerable level is essential in healing.

A) Pharmacological Management: Non-steroidal anti-inflammatory drugs like Ibuprofen and Naproxen are given to relieve pain. Muscle relaxants are given to ease the discomfort. Lidocaine patches are placed on the affected site to provide relief.

B) Bracing: A thoracolumbar bracing (above the hip) known as the TLSO (thoracolumbar sacral orthosis) brace is prescribed to ease movement and improve posture.

C) Nerve Blocks: Patients administered with a nerve block (injecting a local anesthetic along the nerve) in the vertebral column have shown pain reduction for up to two weeks.

D) Physical Therapy and Exercise: Back extensor training is taught to the patients to improve bone strength and decrease fracture risk. Physiotherapy approaches include stretching and strengthening exercises and balance training. Postural taping and manual therapy are also done.

1. Strengthening Exercises: These are aimed at improving lumbar stabilization. It is done to strengthen the muscles of the back, abdomen, glute, and hip.

2. Impact Training for Osteoporosis: Walking or weight-bearing exercise should improve the heart rate enough to prove aerobic conditioning. Avoid running and using inclines on treadmills. Avoid rowing machines. Improve the duration of exercise until reaching the target.

3. Resistance Training for Osteoporosis: It should involve all muscle groups that will affect the body and legs. Hip extension, lumbar extension, leg and chest press, arms cross, and pullover can be done.

• Hip Extension: Lie with one side of the body, touching the floor with one leg over the other. Slowly lift the leg on top a little higher and bring it back to its original position. Repeat this on the other leg. Repeat eight to ten times.

4. Back Extensor Training: It can be done by back extension exercises. Lie flat on the floor or a mat, stretch the forearm forward and tuck them close to the sides. Now slowly raise above the ground with only the chest keeping the legs, hips, and feet stuck to the floor. Hold this position for five seconds and rest for 30 seconds and repeat.

5. Postural Taping: Kinesiology taping is done over the skin to prevent injuries. It helps in postural alignment and supports muscular balance.

What Are the Surgical Options?

Treatments like vertebroplasty and kyphoplasty are done in unresponsive patients with conservative management. Vertebroplasty is a procedure in which bone cement through a needle is injected into the vertebral column that is fractured. Kyphoplasty is a procedure similar to vertebroplasty, but in addition, a balloon is inserted and inflated into the broken column to provide adequate space for injecting cement. It helps in restoring lost vertebral height.

How Can It Be Prevented?

• A fracture cannot be reversed, so preventive measures are crucial. Prevention of osteoporosis begins in childhood by consuming adequate amounts of calcium and vitamin D and continues throughout life.

• Calcium is better absorbed if 500 milligrams or less is taken at once. Vitamin D can be taken in about 400 to 800 international units.

• Women who are nearing menopause can take hormonal supplements. However, maintaining a physically active life throughout is vital to prevent osteoporosis.

• Excessive alcohol use can increase the fracture risk, so it can be avoided.

Conclusion:

Osteoporosis-affected patients are at high risk of developing fractures. Osteoporotic compression fractures are very painful and interrupt day-to-day activities. Hence, swift intervention is necessary. Non-operative treatment protocols have significantly reduced the incidence of fractures and also relieved symptoms of osteoporosis. Exercise is essential throughout life to build and maintain strong bones and muscles. Risk factors leading to osteoporosis can be found earliest and mended for healthy living.