Vertebral compression fractures aff...

Vertebral compression fractures affect approximately 25 percent of all postmenopausal women in the United States. (1) The prevalence of this condition steadily increases with advancing age, reaching 40 percent in women 80 years of age. (2) Women diagnosed with a compression fracture of the vertebra have a 15 percent higher mortality rate than those who do not experience fractures. (3) Although les general in older men, compression fractures also are a major health disquiet in this group. (4-6) Because the age cluster of those older than 65 years is now the fastest growing portion of the U.S. population, the incidence of this age-specific fracture is likely to increase.

According to data bring togethered in 1995, the annual direct medical splendor of vertebral compression fractures in the United States is estimated to be $746 million. (1) Vertebral compression fractures are les expensive compared with hip fractures; however, vertebral compression fractures have a substantial negative impact in succession the patient's function and quality of life. (7) Acute and chronic pain in the somewhat old commonly is attributed to methodical pain from vertebral compression fractures, and frequently leads to further disability. (8)

In addition to physical limitations, vertebral compression fractures may yield a psychosocial and emotional capacity on the aging person who already faces losse of independent function. This may cause the part to worry about what the events to come may bring. These worries are not unfound because there is a substantial risk of succeeding fractures of all types and further morbidity in [i]role[/i]s who have had a vertebral compression fracture. (9)

Pathophysiology and Risk Factors

Vertebral compression fractures are recognized as the hallmark of osteoporosis,10 and many of the risk factors are the same. (11) Risk factors are categorized as those not modifiable and those that are potentially modifiable. Nonmodifiable risk factors include advanced age, female sex Caucasian race, presence of dementia, susceptibility to falling, history of fractures in adulthood, and history of fractures in a first-degree relative.

Potentially modifiable risk factors include being in an abusive situation, alcohol and/or tobacco use, demeanor of osteoporosis and/or estrogen deficiency, early menopause or bilateral ovariectomy, premenopausal amenorrhea for more than undivided year, frailty, impaired eyesight, insufficient physical activity, depressed body weight, and dietary calcium and/or vitamin D deficiency.

Fracture rates are lower in principally nonwhite populations, but vertebral compression fractures are as frequent in Asian women as in white women Ironically, obesity is protective to fractures as it is to bone los in general.

Acute fractures come about when the weight of the upper material substance exceeds the ability of the bone within the vertebral material part to support the load. Generally, about trauma occurs with each compression fracture. In cases of simple osteoporosis, however, the cause of trauma may be simple, like as stepping out of a bathtub, vigorous sneezing, or lifting a trivial purpose or the trauma may proceed from the load caused by dint of muscle contraction. (12(p 880-1)) Up to 30 percent of compression fractures appear while the patient is in bed. (13) In cases of moderate osteoporosis, more force or trauma is required to create a fracture, as it is as falling off a chair, tripping, or attempting to lift a heavy end Of course, a healthy spine can sustain a compression fracture from cruel trauma such as an automobile crash or a hard fall.

The applied force usually causes the anterior part of the vertebral visible form [i]or[/i] frame to crush, forming an anterior wedge fracture (Figure 1) The middle file remains intact and may act as a hinge. This accrues in loss of anterior height of the vertebra while the posterior height remains unchanged. As the collapsed anterior vertebrae fuse together, the spine bends forward, causing a kyphotic deformity. Because the majority of damage is limited to the anterior vertebral round pillar the fracture is usually stable and rarely associated with neurologic compromise. (14) A fracture is considered a "burst fracture" if the entire vertebral material part breaks (Figure 2).

Spinal compression fractures can be insidious and may furnish only modest back pain early in the course of progressive disease. throughout time, multiple fractures may deduction in significant loss of height. Progressive los of stature arises in shortening of paraspinal musculature requiring lengthened active contraction for maintenance of attitude resulting in pain from muscle fatigue. This pain may continue drawn out after the acute fracture has healed. (15)

Patients unfold thoracic kyphosis and lumbar lordosis as vertebral height is missing The rib cage presses down upon the pelvis, reducing thoracic and abdominal space. In harsh cases, this results in impaired pulmonary function, a protuberant abdomen, and--because of condenseed abdominal organs--early satiety and weight los (16) Complications from compression fractures are summarized in Table 1