Osteoporotic compression fractures

These are low energy fractures in elderly patients

Differential includes

• Tumour
• Metastatic disease
• Infection

These fractures may lead to progressive loss of height, kyphosis, postural changes, deconditioning, and persistent pain that may interfere with activities of daily living.

Treatment options for osteoporotic compression fractures:

• Nonoperative - NSAIDS, analgesics, orthosis (for pain and limit progressive deformity), Bisphosphonates

• Surgery - rarely (burst fracture with canal compromise and neurologic deficit, or in multiple compression fractures producing a gibbous) Reconstruction of the osteoporotic burst fracture is made difficult by the underlying osteoporosis and the frequently associated comorbid conditions in the elderly.

• Vertebroplasty - Injecting cement or calcium phosphate into a fractured vertebral body. Pitfalls  include intravascular injection, extrusion of the injected substance posterior to the vertebral body, causing neural compression or thermal damage and fracture adjacent to the treated vertebrae.

• Kyphoplasty - Balloon catheter introduced into the collapsed vertebral body and inflated, elevating the depressed cortical endplate. Cancellous bone is impacted outward, creating a walled void within the vertebral body. Cement is then injected into the vertebral body and used to maintain the “pre-fracture” vertebral body height.

Last updated 11/09/2015