JOIN USIn fact, she suffered a vertebral fracture – a compression, or crushing, of the front of a vertebra, one of the 33 bones that form the spinal column. This injury is very common, affecting a quarter of postmenopausal women and accounting for half of the 1.5 million fractures due to bone loss that occur each year in the United States.
By age 80, two in every five women have had one or more vertebral compression fractures. They often result in chronic back pain and impair the ability to function and enjoy life. They are one reason so many people shrink in height as they age.
Multiple vertebral fractures, found in 20 per cent to 30 per cent of cases, often result in a hunched posture, a condition called kyphosis that impairs breathing and compresses the abdomen, leading to a protruding stomach with limited capacity.
But while vertebral fractures are a telltale sign of bone loss among women over age 50 and men over age 60, most who suffer them are unaware of the problem and receive no treatment to prevent future fractures in vertebrae, hips or wrists, the bones most likely to break under minor stress when weakened. Yet, if a vertebral fracture is diagnosed and properly treated, the risk of future fractures, including hip fractures, is reduced by half or more, studies have shown.
“Most vertebral fractures do not come to medical attention at the time of their occurrence,” Dr Kristine E Ensrud and Dr John T Schousboe wrote recently in The New England Journal of Medicine. One reason is that the pain may be minimal at first or, if more severe, attributed to a strain that subsides over a few weeks. Indeed, patients or their physicians are made aware of these fractures in just one-fourth to one-third of the instances in which they are discovered on X-rays, according to the doctors.
Ensrud, an internist and epidemiologist who researches osteoporosis at the University of Minnesota and the Veterans Affairs Medical Centre in Minneapolis, noted that in a person with severe osteoporosis, a vertebral fracture can be caused by something as mundane as coughing, sneezing, turning over in bed or stepping out of a bathtub. In patients whose bone loss is less advanced, a fracture may occur when lifting something heavy, tripping or falling out of a chair.
“A lot of the time, people don’t recall the incident,” Ensrud said. “They just report that their back has been bothering them.” Patients also may mistakenly assume that their chronic discomfort is a result of arthritis or a normal consequence of age, and never mention it to their doctors.
Yet the occurrence of vertebral fractures means that the situation is worse than bone density testing would suggest. “The identification of a vertebral fracture indicates a diagnosis of osteoporosis,” Ensrud and Schousboe concluded in their article. Asked if such women should receive bone-preserving medication, Ensrud said emphatically, “Yes!” One major study found that a vertebral fracture raises the risk of further vertebral fractures by five times in just one year.
Prevention of fractures
Future fractures can often be prevented if a bisphosphonate is taken by someone found to have one or more vertebral fractures, even if these fractures cause no discomfort.
There are many other bone-building options, too, including a once-a-year injection. In addition, patients should consume adequate amounts of calcium and vitamin D, the critical nutrients for strong bones: a total of 1,200 milligrams of calcium daily from food and supplements, and 1,000 international units daily of vitamin D.
Initially, a painful vertebral fracture may be treated with a short period of bed rest and pain medication like a nonsteroidal anti-inflammatory drug, narcotic, pain patch or an injection or nasal spray of calcitonin. But if too much time is spent in bed, the resulting weakness can increase the risk of further fractures.
Whatever is done, or not done, to treat the injury, the pain of a vertebral fracture usually subsides over the course of several weeks. Ensrud and Schousboe cautioned in their article against rushing into two invasive procedures that have become increasingly common in this country: vertebroplasty and kyphoplasty. During these procedures, a kind of cement is injected into the compressed vertebra to stabilise it. The operations are performed by interventional radiologists who, naturally, endorse them enthusiastically.
However, two scientifically conducted studies of vertebroplasty using sham procedures as a control found no benefit with respect to pain, disability or quality of life. Exercises to improve posture, strengthen back muscles and enhance mobility are less costly and likely to be more effective in the long run, the doctors wrote.It is critically important to know what not to do.
Avoid those infamous stomach ‘crunches’ and toe touches and any exercise or activity that involves twisting the spine or bending forward from the waist with straight legs. Next, recall a mantra you may have heard often as a child: Stand up straight.
Good posture – proper alignment of body parts when you stand, sit or walk – reduces stress on the spine. Lift your breastbone, and keep your head erect and shoulders back, all the while gently tightening abdominal muscles and maintaining a small hollow in your lower back.