The natural history of the osteoporotic vertebral fracture

Abstract

The clinical picture of the osteoporotic fractures of the spine presents an heterogeneity in their intensity and duration. In 210 cases of osteoporotics with acute pain and radiological evidence of spinal fracture we separate their clinical picture in two groups. In Type I (121 cases) pain is acute and severe, improving gradually; the vertebral wedging is obvious from the beginning and remain unchanged. The duration of this event exceeds 4-8 weeks. In Type II (89 cases) pain is less and of shorter duration, but after 6-16 weeks a new attack of acute pain presents. This picture can be repeated for 6-18 months. Radiologically the fracture is not clear during the first attack but wedging gradually developed during the next months. Bone density of the lumbar spine (DPA) was measured in all cases. Type I had a significantly lower BMC than Type II. We suggest that patients with unclear vertebral fractures, minor symptoms and relatively high bone mass must classified in Group II and deterioration can occur during the next months. Long term treatment and additional orthopaedic prevention is needed. In Group I a short term calcitonin treatment helps early relief and mobilization.

Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study

“…These include short vertebral height (SVH), which they report as being more common in older, heavier women, unrelated to osteoporosis [40,41], equally prevalent in preand postmenopausal women [41], and therefore unimportant. However, the limited evidence on the natural history of "mild" vertebral deformities suggests that they do predict subsequent fracture [5] and may even represent an epidemiologically distinct subtype of vertebral "fractures" [42]. This may also explain the different demographic pattern of women with SVH between pre-and postmenopausal women in Ferrar and colleagues' comparison of these groups [41].…”

Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis

“…When an acute OVCF occurs, the pain may be so devastating and disabling that hospital admission is required; length of stay for such fractures may be as long as 10 to 14 days [6][7][8]. On the other hand, OVCFs may be associated with mild back pain and stiffness, and the diagnosis of a fracture often goes unnoticed [9].…”

Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures

“…Previous studies have found that medical management of symptomatic VCFs often fails to improve pain and mobility particularly in cases of chronic pain related to kyphotic deformity [27,31,41]. Furthermore, long-term use of narcotic analgesics and anti-inflammatory drugs are poorly tolerated by elderly patients.…”