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When our own bones betray us

When I was a kid, I saw my grandparents at most once a year, as one set lived 500 miles east and the other 400 miles west of where I grew up. I remember being surprised at how short my grandmothers were getting at each subsequent visit, and it wasn’t just because I was getting taller.

They both suffered from osteoporosis, and the spinal compression fractures that often accompany that disease.

Osteoporosis is a condition where the bones lose their density, becoming more porous and weak. When this happens in the bones of the spine, the bones may weaken to the point where a vertebral compression fracture can occur.

This type of fracture isn’t what we typically think of when a bone breaks. The vertebra doesn’t break into two or more pieces; it compresses down on itself in the front of the part of the bone, making the shape of the bone more of a triangle than a square.

If VCF happens in multiple vertebrae, this loss of height on the front of each one causes the back to curve over in a “hunchback” appearance. This can lead to a lot of pain in the short term and difficulty breathing in the longer term as the area needed for the lungs to fully expand shrinks.

According to the American Academy of Family Physicians, vertebral compression fractures affect approximately 25 percent of all postmenopausal women in the United States. As women get older, the incidence increases, reaching 40 percent in women 80 years of age.

Although less common in older men, compression fractures also are a major health concern in this group. As the American population ages, the number of people affected by this condition is likely to increase.

Those at highest risk of experiencing a VCF are older, white women. The risk increases with dementia and a history of falls. Other risk factors include being in an abusive situation, alcohol or tobacco use, presence of osteoporosis and/or estrogen deficiency, early menopause, frailty, impaired eyesight, insufficient physical activity, low body weight, and dietary calcium and/or vitamin D deficiency.

One of the most difficult aspects of this condition is that these fractures can occur without any trauma. A cough, a sneeze, turning over in bed or reaching for something can cause a VCF if severe osteoporosis is present.

With less advanced disease, the fracture can occur due to a fall or other mild trauma. Even a healthy spine can experience a VCF, usually due to a car accident or serious fall. Rarely, this type of fracture can be caused by cancer of the bone.

The most obvious symptom of VCF is pain that can begin almost immediately after the fracture, although sometimes it is delayed. Diagnosis is usually made by history and some type of X-ray or scan. A short period of bed rest, over-the-counter pain relievers and physical therapy are the usual first-line treatments.

If these treatments don’t relieve the pain after a few weeks, there are two surgical procedures that can be tried. A vertebroplasty is a procedure where a type of medical cement is injected into the break to stabilize it, relieving the pain quickly.

The second surgical alternative is kyphoplasty, where a small balloon is inserted into the bone and inflated to restore the height to the bone before the cement is injected to maintain the vertabra’s structure. According to Dr. David Findlay of Noyes Hospital, kyphoplasty “has the ability to not only buttress and heal the fracture site with bone cement, but also help restore the height of the compressed vertebra.

Kyphoplasty can improve the alignment of the spine to minimize stress on adjacent vertebra to help prevent them from fracturing as well.” Dr. Findlay is part of a team at Noyes that performs kyphoplasties on patients whose pain from a VCF does not respond to conservative treatment.

I wish my grandmothers had had access to these new types of treatments. Their pain and disability from VCF made their lives much more difficult in their declining years.

Who knows? By the time I am old, maybe there will be cure for osteoporosis so these types of injuries will be a thing of the past.

Pam Maxson is a health educator at Noyes Hospital in Dansville. If you have questions or suggestions for future articles she can be reached at pmaxson’@noyes-hospital.org or 335-4327.