If left untreated multiple fractures may occur in the spine. In many cases vertebral compression fractures can be obscure and go unnoticed. Whereas patients that have no presence of osteoporosis require severe trauma such as a car accident or a fall from height. In patients that have moderate osteoporosis, fractures can occur with low velocity trauma such as falling from a chair or lifting a heavy object. In the presence of severe osteoporosis theses fracture can occur during the most unassuming things for example lifting a small object, a vigorous sneeze/cough or turning in bed. The majority of compression fractures occur between T12 and L2 due to the forces exerted. In very rare cases bowel or bladder incontinence is possible if the fracture has affected the nerves that control these functions, however, in my experience I have never seen this and I’ve personally seen hundreds of compression fractures. You may find difficulty walking or standing and very rarely you might experience numbness or tingling in the arms or legs. Patients mostly complain of back pain after trauma such as a fall. Sometimes compression fractures are also called anterior wedge fractures, wedge fractures, collapsed vertebrae, osteoporotic vertebral fracture, or occasionally patients describe having a “crumbling spine” which is a term we don’t recommend is used. Typically, compression fractures can occur through trauma, infection, poor bone density or cancer. However, men over the age of 65 are also at risk of compression fracture. Often it is a complication secondary to osteoporosis and the risk of fracture increases with age, being female and post-menopausal. A compression fracture occurs when one or more of the bones in your spine (vertebrae) collapse or become compressed due to injury or bone weakness. Vertebral compression fractures are fairly common fractures in older adults with osteoporosis, mostly seen in the junction of the thoracic and lumbar spine. 26 Nonsteroidal anti-inflammatory drugs have been shown to significantly increase gastrointestinal bleeding in the elderly and must be used with caution.5 Best Exercises following Vertebral Fracture 25 Muscle relaxants, external back-braces, and physical therapy modalities also may help. Calcitonin-salmon (Miacalcin) nasal spray can be used for treatment of pain. If bowel sounds and flatus are not present, the patient may require evaluation and treatment for ileus. Oral or parenteral analgesics may be administered for pain control, with careful observation of bowel motility. Prolonged inactivity should be avoided, especially in elderly patients. Patients are treated with a short period (no more than a few days) of bedrest. Traditional treatment is nonoperative and conservative. Fortunately, compression fractures are normally stable secondary to their impacted nature. A stable fracture will not be displaced by physiologic forces or movement. The physician must first determine if the fracture is stable or unstable. Family physicians can help patients prevent compression fractures by diagnosing and treating predisposing factors, identifying high-risk patients, and educating patients and the public about measures to prevent falls. Interventional procedures such as vertebroplasty can be considered in those patients who do not respond to initial treatment. Traditional conservative treatment includes bed rest, pain control, and physical therapy. While the diagnosis can be suspected from history and physical examination, plain roentgenography, as well as occasional computed tomography or magnetic resonance imaging, are often helpful in accurate diagnosis and prognosis. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening decline in the elderly patient who already has decreased reserves. Vertebral compression fractures usually are caused by osteoporosis, and range from mild to severe. Compression fracture of the vertebral body is common, especially in older adults.
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