The most common osteoporotic fracture, vertebral compressions (VCF) reflect bone fragility and will often push a patient down a path of increased morbidity. VCF symptoms can include impaired gait, disability, reduced lung function, early satiety, future fracture risk and mortality.
The National Osteoporosis Foundation estimates that 10 million Americans have osteoporosis. As a result of the population advancing in age and changing diet, the fracture rate isn't diminishing — U.S. osteoporotic-caused fractures will likely reach 3 million by 2025, up from 2 million in 2005.
Patients who have a VCF face a five-fold increased risk of suffering a subsequent vertebral fracture when compared with their pre-morbid condition or age matched controls. As the number of prevalent vertebral fractures increases, so does the risk for additional fractures as well as the mortality rate.
As clinicians face an increasing number of VCF cases, they should consider the benefits of vertebroplasty and kyphoplasty to reduce patient pain and improve quality of life.Threat of undiagnosed osteoporosis and VCFs
The number of people suffering osteoporotic fractures nationwide is increasing, especially among older women. The January 2015 issue of Mayo Clinic Proceedings featured an article comparing hospitalizations for various conditions to hospitalizations for osteoporotic fractures in women 55 years and older. The 12-year study revealed 4.9 million hospitalizations for osteoporotic fractures in women, more than myocardial infarction, stroke or breast cancer.
Many experts now realize that there is a crisis caused by the declining rate of testing, diagnosis and treatment of high-risk patients. If these patients go untested and untreated, the consequences may include debilitating fractures that cause disability, loss of independence and even death.
Osteoporotic fractures account for a significant economic burden on the healthcare system, but identifying high-risk patients early can lead to better care and lower treatment costs.
Currently two-thirds of VCFs are initially asymptomatic and under-diagnosed; this provides opportunity for clinicians to proactively drive education on the risks associated with osteoporosis and spine fractures as well as the associated economic impact on the healthcare environment.
A misunderstood condition
Many clinicians are under the impression VCFs are untreatable and thus dubbed them "benign fractures," but this is a mistake.
We had [in the 1980s], a conceptual framework that was based on how younger people heal vertebral compression fractures. In reality, the elderly often take longer to improve their pain and can decline during the period of conservative therapy.
In the 1980s, French practitioners developed a technique to percutaneously inject cement into the bone. While the incident case was a benign tumor of the cervical spine, these physicians soon realized the same technique could be used to stabilize fractures and rapidly reduce the associated pain. Interventional radiologists and surgeons in the United States later saw this procedure and mirrored it with vertebroplasty. Researchers then developed a cousin procedure — kyphoplasty, which involves mechanically treating the fracture by inserting and inflating a balloon to create an open cavity inside the bone for injecting bone cement designed to stabilize the spine.
Now, there is a greater appreciation for osteoporosis as a medical problem and vertebroplasty or kyphoplasty as a solution for quicker pain relief.
A variety of treatment methods now exist for VCFs, but biases and misinformation still circulate.
A heated debate about whether augmentation offers a mortality benefit has captured the industry for years, resulting in a variety of trials.
Several recent large clinical studies followed patients for at least 12 months after VCF. Four studies revealed balloon kyphoplasty and vertebroplasty offered patients lower mortality risk compared to those patients receiving non-surgical management.
The mortality benefit always made intuitive sense when one compared the fundamental tenets of conservative therapy which include limitation of activities, back brace and narcotic medication to early mobilization.
Balloon kyphoplasty is one of the few treatment solutions in clinical studies to give patients pain relief and quality of life.
To prove the technique's effectiveness, the 21-center Fracture Reduction Evaluation study compared Balloon Kyphoplasty with non-surgical treatment for acute VCF. Researchers found balloon kyphoplasty relieved back pain, enhanced patient satisfaction and improved mobility and quality of life to a greater effect than non-surgical care.
To read the full article or more about the studies: Becker’s Spine Review