The National Osteoporosis foundation
estimates that 10 million Americans have
osteoporosis, with a fracture occurring
every three seconds worldwide.
Fractures in the vertebra of the spine are
common in people with osteoporosis and
often go unnoticed until consequences
such as severe pain or lack of mobility
On today's show the impacts of
osteoporosis: what you need to know about the
often silent disease.
I’m Ereka Vetrini, Access
Health starts now.
[Music] Elderly related osteoporosis is
exceedingly high, if you go back ten
years and forward ten years the osteroporatic
patient population is an issue.
This is a huge demographic.
Osteoporosis means porous bones and is a
disease that causes bones to become weak and
brittle often leading to fractures of
the hips, spine and wrists.
I see a lot of elderly
people and they're scared and they hurt
because they've gone from being an
active person in their community to now
there, they can't walk they're in a
My name is Joyce Wagoner and I am 76
years old I fell in a store and there
was water on the floor and I slipped and
went down on one knee and I coul feel or hear it pop but I didn't
I thought it was my knee instead
of my back.
I did go in and have the knee check
but I didn't have the back check I
thought oh I had just pulled my back and
you know it hurt but not severe.
I was riding in the car with my
daughter Janice and when she'd go across
a railroad track or a bump I would
just hurt something terrible and then
I couldn't sleep at night because
I couldn't lie flat.
My name is Eddie Lou
Halsey and I'm 92 years old and I live
in Guthrie, Oklahoma.
I tackle anything
that a woman my age would do and some
things that probably women my age didn't do.
I drove myself, I went to all the
functions of an that I need to go to, and
whenever anybody needed anything from, I'd pitch in.
I was in the
church and we had had a dinner and I had
a casserole that I was carrying and
going home, and I tripped on a rubber mat
that they had in front of the door and
just went, just fell flat hit my head and
knocked myself out.
I knew that there was something wrong
because my back was hurting terribly and
if, I was taken home and it never did
quit hurting, so I knew I had to do
I didn't know that I had
osteoporosis no one had ever really
pinned it down to that.
So I wasn't
thinking about that but I certainly
thought about it after I fell.
Joining me today to discuss what we need
to know about the prevention, early
diagnosis and treatment of osteoporosis
is Dr. Heather Hofflich professor of
medicine at the University of California,
San Diego Health Sciences.
Welcome doctor, hi Ereka, thanks for having me
I’m so glad you're here we have so much
to cover in this show so let's start
from the very beginning what exactly
Osteoporosis is a silent disease most times until
an actual fracture occurs and
actually the incidence of osteoporosis
annually is even more than the incidence of
a stroke, heart attack, and breast cancer
So it's a very common problem as we age
we lose our bone density, and thus that
can lead to fracture.
There are other
non-modifiable causes of osteoporosis,
having a family history is an extremely
common reason, if your mother or father
were to fracture a hip or have osteoporosis your chances are
much higher of also having
osteoporosis, as women reach menopause we lose
our estrogen and Men as they age
also have declining testosterone levels,
and this too leads to reduce bone density
and osteoporosis the other risk
factors there are many modifiable ones
and that's what we work hard on in
our clinics to prevent further bone
loss some of them include cigarette
smoking, which is directly toxic to the
bone, alcohol use more than two
glasses a day in woman and three glasses in
men is something that we can change
poor diet lack of exercise so there are
many things that we can change and
work on and help prevent osteoporosis.
Doctor how is osteoporosis diagnosed?
The best test
to diagnose osteoporosis is a bone
density scan or DEXA scan that should be
done in all women aged 65 years or older
as per the National Osteoporosis Foundation guidelines and also
men greater than age 70 and older so
that we can detect the silent disease.
It seems like in the elderly it's very
common to have fractures of the hip or the
wrist is this osteoporosis?
Typically it is
osteoporosis and spine fractures are
definitely the most common fractures
that are seen.
How do we know if we have
a spinal fracture what are some of the
Debilitating pain can often be a
signal that someone has a fracture and
so when I see a patient that is in an
awful amount of pain, I we'll go ahead and
get an x-ray however two thirds of
spine compression pressures are silent
and are picked up incidentally on x-rays
so we need to have another way to try
and find these it is important that we
intervene at the time of the fracture and
that is where the role of a hospitalist
comes into play, they are seeing the
patient submitted through the emergency
room that have the fractures and it's
important that they identify and directly provide care for these
So it sounds like the hospital if is a
crucial part of the process of getting
to the patient and we're going to take a
short break but first Access Health
caught up with Dr. Syed for more on the
hospitalist role in osteoporosis, take a
Patients come to the ER because
pain, majority of the time, when pain
goes away people think that we can treat
it everything is fixed and there's
no further worries and the life
goes on That's a misperception because
if you don't plead the underlying
process which is causing the problem you'll
get back to the years in a matter of
If you have a fracture, you have
significant osteoporosis and or the period
of time is going to get worse and you'll
have more fractures and your quality
of life is going to go down.
Coming up treatment
options for the impact of osteoporosis.
(Music) Welcome back I'm here with
endocrinologist Dr. Heather Hofflich and
before the break we were talking about
the diagnosis and impacts of fractures
related to osteoporosis, doctor can we
now talk a little bit about the treatment for spinal fractures?
There are both non-surgical and surgical
treatments for spinal fractures, at UCSD
where I work we're very lucky to have a
wonderful orthopedics team, if a patient fractures whether
it be in the ER, the inpatient team or
outpatient, the patients are referred to
orthopedics and seen within 24 to 48 hours
particularly with spine fractures the
patient is seen immediately, they are put
in a brace, given proper exercises and
instructions, and they are given a
complete pain management program and
seemed back with an appropriate plan.
This has been wonderful and a great
resource for our patient there is a
minimally invasive surgeries that are
possible to infer them reduce their pain.
Thank you Heather we're going to see you
a little later in the show and let's go
now to Dr. Douglas Beal, Chief of
Radiology Services at clinical Radiology
of Oklahoma to learn more about this
minimally invasive procedure.
The issue about patients with vertebral
fractures, pain is that they lie in bed,
that they get pneumonia, blood clots to the
lungs, DVTs and they typically don't do
better, they do poorly.
End these patients die at a very high rate
so your typical patient is they're
distraught with pain you can see a
broken arm or broken leg but you can't
see a broken vertebrae and so people
don't understand until you truly have
one or experienced a broken bone.
Patients will exhibit specific symptoms
they're very textbook, it's a sharp
shooting pain, it's much pain with
movement it's pain with any transition
type pain from sitting to standing or
sitting to lying or breathing.
So vertebral plasticies we need to
put a needle into a vertebral body
inject medical cement and that's a
tried and true methods been present for a long
time - kyphoplasty and balloon
kyphoplasty, we put the needle in and then we balloon
the vertebra try to make it look
more normal, we call these vertebral
compression fractures because they're
compressed top to bottom, we inflate the
balloon it raises it back up from top to
bottom reestablishes the height of the
vertebral body and it also creates
area within the bone and cavity so
whatever we injected revelat controls, the
Cement goes to the path
with least resistance.
The patients that we see are typically
coming to us from their primary care
physician or from a specialist typically your neurosurgeons or
orthopedic surgeons or endocrinologist
even primary care doctors will put a
patient in a brace because they see the
fracture they understand it's a broken
bone and they are going to the adage
that the bone turnover will then heal the
bone but you're dealing in an older
population with osteoporosis where the
bone turnover is not fast at all it's
not like a 16 year old that breaks an
arm in a soccer tournament, this is a
this is a older person that after
menopause or later in life you don't
turn your bone over, it just don't
Average patient I see will
have a fracture between two and four
months old, used to be worse used to
be six months in a year, and patients
that survived that, survived the decondition are able to be
After I fell the pain kept getting
worse and worse
and I knew there's something, that
there was something wrong and it took me
about three weeks, two or three weeks I believe before I went to
Dr. Beal and he immediately knew
what it was.
The MRI showed 3 fractures and then he
told me I needed to have the kyphoplasty.
He did an MRI and that's why he decided
I had done had, had and had broken my
vertebras, crushed them.
We diagnosed a
fracture with either x-ray CT or MRI and
we treat them based on the presence of a
fracture associated with pain, a fracture
that's important, one that is is one that
is symptomatic one that hurts so a
fracture combined with pain combined
with patient debilitation equals need
So surgical procedure for someone that
comes in with a vertebral compression
fracture include born kyphoplasty and
this is done when the skin is numbed and
we identify the appropriate starting
position from x-ray live x-ray or
The kyphoplasty is accessing
the fracture putting the balloons and
trying to make the request partiro body
look more normal, raise it up to normal
We insert the balloon inflate the
balloon with contrast something you can
see on x-ray and then once the balloon
is deflated we take it out and we inject
the cement and then after the fillings
complete we wait for the cement to
harden and so it hardens completely in
about 20 to 25 minutes, by the time we
remove the needles the cement is hard
enough to support lots of weight and the
patient is immediately able to roll back
over onto the gurney to go to the
holding area the waiting room and
There are risk to the procedure
including serious complications including infection and leakage
of bone cement into the muscle and
Cement leakage into the blood vessels
may result in damage to the blood
vessels lungs heart and/or brain.
into the area surrounding the spinal
cord may result in nerve injury that can,
in rare instances cause paralysis.
See the end of this segment for
important safety information.
What I see in the recovery
room and recovery period is that patients are resting and they
feel better and they're able to sleep
and they're able to get dressed and
they're able to to move about.
When I came out I
could tell it was fixed.
Take it easier
for a couple of days but there really no
I walked in painfully, but
after I had the surgery and they took me
to a room I was pain-free, I did not feel
any of the pain anymore and then when
they wanted to wheel me out and wheelchair I said I will walk so
I walked to the car and didn't
have any problem at all, I went home that
After invertible augmentation recoveries
not much people were a little sore three
or four days after the surgery, but it's not
The largest trial ever
done 354 patients, number of complications or adverse events,
It gets them out of pain, it gets them
back to their daily activities of living,
it helps them be part of the community
If you have one fracture you have
about a five times increased risk of
another one, two fractures goes up to 12
times, so I usually tell people it's not
if it's when.
I think it was probably a
month later that they found the other
fractures and had to have that taken
care of and then I've been free of pain
Two days later I believe it
was I coughed or something, anyway I've
fractured the vertebra right above the
one he fixed and he went back in and
fixed that one and then I was fine and I
have been fine ever since and if I ever
have another fracture, I know it can be
fixed and I will recognize it immediately.
Joining us now is Michael
Switzer an interventional therapy
consultant, welcome Michael.
Thank You Erika.
So tell me as an interventional therapy
consultant what does your job entail.
Well we wear many hats, really our
foremost role is to make sure that
patients have access to balloon kyphoplasy.
So we just watch Dr. Bill
perform a balloon kyphoplasty, tell us
about the clinical evidence behind it.
We've had many patients that have been
involved in our clinical trials, most
recently a study of 300 patients where
roughly half of them received conservative non-surgical
management and the other half received balloon
kyphoplasty In that study they found that
within the first week the patients that
received kyphoplasty had a three times
greater improvement in their pain.
At one month those patients reported
having a four times better improvement in
their quality of life and in that
first month they also reported having five
fewer days with limited activity,
versus the non-surgical management
Those are great numbers, it sounds
like a wonderful option for the
patients you support.
Thank you Michael for stopping
by, and we'll be back in just a moment so
stay with us.
We're back and I'm here with
endocrinologist Dr. Heather Hofflich, so
Heather so far we've talked about the
non-surgical and surgical treatments of
spinal fractures, but can we now talk
about the treatment of osteoporosis as a
There are many FDA approved
osteoporosis medications and they can
come in oral, intravenous, or injectable
The goal of therapy is to actually
stop the breakdown a bone and there is
one therapy that actually truly builds
back bone density, these medications are
so important to reduce the risk of
fracture and if somebody has osteoporosis I highly encourage
them to speak with their physician and
to consider one of these therapies.
So doctor I know there's no cure
for osteoporosis but what can we do
to prevent it.
There are many things that we
can do to prevent osteoporosis and
improve our bone health.
Calcium is one
of the building blocks of bone and it is
a very important part in building bone
What I do in my office with my
patients I have them look at the National Osteoporosis foundation
calcium calculator and I have them go
home and calculate how much they really
are getting in a normal day.
is not getting enough calcium their diet
then supplementation is okay as well.
Vitamin D is another important building
block for our bones, another important
component of bone health is exercise and
by this we mean weight-bearing exercise;
walking, jogging, elliptical.
educate my patients in the exam room
about protecting themselves from a fall.
Seventy-five percent of falls cause a
fracture and that's what we're trying to
There's a great handout on the
National Osteoporosis foundation website
that teaches people about some tips to
Doctor thank you so much
for spending time with us today and
giving us so much great information.
Thank you to all of my guests and
especially our patients for sharing
their personal stories.
For more information on all the
information we discussed on the show today you
can visit spine-facts.com
or the National Osteoporosis foundation
website at nof.org, and of course you can
log on to our web site access health dot TV,
see you next time.
Balloon kyphoplasty is a minimally
invasive procedure for the treatment of
pathological fractures of the vertebral
Due to osteoporosis, cancer or
benign lesion, there are risk to the procedure
including, serious complications including infection and leakage
of bone cement into the muscle and
tissue Cement leakage into the blood vessels
may result in damage to the blood
vessels, lungs, heart, and/or brain.
Cemnent leakage into the area surrounding the
spinal cord may result in nerve injury
that can in rare instances cause
A prescription is required.
This therapy is
not for everyone, please talk to your
doctor about the risks and benefits of
this procedure and to decide whether
this procedure is right for you.
Results may vary, for more information
please call Medtronic at one seven six
three five oh five five zero zero zero
and or consult Medtronic website at
Medtronic dot com