Osteoporotic fractures of the spine.
Fractures of the spine are the most common fractures in old age.
Osteoporotic fractures of the spine are one of the most common types of fracture and in light of the increasing average age of the population pose a serious clinical problem. They occur in about 10% of women aged over 55, and the incidence increases to more than 40% after the age of 80.
The mid thoracic spine is most commonly affected, as well as the transition from the thoracic to the lumbar spine. The consequences of such fractures are severe pain with deformities of the spine. Only about one third of fractures to the vertebrae result in clinical symptoms. Vertebral fractures often go undetected, but can also induce excruciating back pain as far as destructive pain.
Osteoporotic fractures of the spine. Information from A - Z.
Definition. What are osteoporotic fractures of the spine?
There are three types of fracture:
- Biconcave spinal fracture with sintering (collapse) of the central vertebral body, most commonly found in the lumbar region
- Wedge fracture, with collapse of the front (anterior) column and a predominantly intact rear (posterior) column. They tend to occur in the area of the mid thoracic spine and thoracolumbar transition
- Total impacted fracture with collapse of the entire vertebral body. This likewise occurs mainly in the mid thoracic spine and the thoracolumbar transition. In figures, the wedge fracture is most common, followed by biconcave and total impacted fractures. Combinations of fractures are typical in advanced stages.
Incidence of osteoporotic fractures of the spine.
Osteoporotic fractures of the spine often result from a fall, but more often they occur spontaneously after minimal trauma (e.g. coughing, lifting injuries, bending the upper body or twisting). More than 50% of fractures to the vertebrae can be attributed to a specific incident. They occur very often at the thoracolumbar transition (Th10-L2), as well as the mid-thoracic region (Th4-10). On the other hand, fractures to the upper part of the thoracic spine (Th1-6) are more commonly found as a result of a metastatic process or any other malignant bone process (plasmocytoma). Magnetic resonance imaging generally permits differentiation between benign and malignant disease but cannot distinguish between fractures caused by trauma (violent force) and osteoporosis.
Symptoms. Signs of osteoporotic fractures of the spine
Complaints with osteoporotic fractures of the spine.
The symptoms of osteoporotic fractures of the spine are very different. Most patients are almost painless, while others complain about radiating severe pain. The reasons for the bandwidth of pain experience are unknown. In addition to recurrent trabecular microfractures, also a kyphotic related chronical overloading of the back muscles, a possible secondary osteoarthritis of the facet joints with nerve irritation and a permanent irritation of the periosteum of the vertebral body are discussed as a cause of pain.
Although many patients are pain-free after a few months of conservative therapy, others complain even after years of persistent tension pain tension that occur during loading of the spine (eg, bending over, standing up). A strengthening of this diffuse pain may be caused by new vertebral fractures. These rarely lead to neurological deficits similar to those of radiculopathy (damage to the nerve root) with intervertebral disc injury.
Changes in body shape due to spinal fractures.
By osteoporotic fractures of the spine, there are changes in body shape with a shorter body height, forming a hump and the bulging of the abdomen. This not only leads to a functional impairment of lung and intestine, but also to a loss of self-esteem and reduction in quality of life.
Causes. How osteoporoctic fractures of the spine occur
Osteoporotic fractures of the spine often occur in women.
Osteoporotic fractures of the spine tend to occur in elderly women, in whom above all there is a loss of trabecular bone. This means the inside of the bone, the majority of which consists of fine, sponge-like supporting bone (Latin trabecula = small beam). The cortical sheath (outer layer of bone) of a vertebral body, which absorbs compression forces, amounts to only about 10%. Trabecular ratification of the vertebrae, combined with advancing degeneration of the intervertebral segments in old age, lead to intensified axial (from top to bottom) strain on the base and cover plates which, once a critical level has been exceeded, results in fracture of the vertebrae. Though microfractures can heal with newly formed bone tissue (callus formation), their accumulation leads to compression fractures with a reduction in individual vertebral height. A reduction in vertebral height by 20% or by 4 mm is indicative of a compression fracture of the vertebra, which can be diagnosed by taking X-rays of the spine from the side.
Osteoporosis is a truly widespread disease and is among the most common diseases among the elderly.
Diagnostics & Therapy
Most symptomatic, osteoporotic fractures of the vertebrae can be successfully treated with conservative measures.
Help with back pain: Our specialized clinics for diagnostics, treatment & therapy of osteoporotic fractures of the spine at a glance.