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The Impact of Vertebral Compression Fractures

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

occur.

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

wheelchair.

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

something.

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.

(music.)

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

today.

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

causes osteoporosis?

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

combined.

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

signs?

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

patients.

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

look.

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

time.

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.)

(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 better.

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

heal fast.

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

treated.

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

for treatment.

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

fluoroscopy.

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

height.

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

recovery.

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.

Cement leakage

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

restrictions.

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

evening.

After invertible augmentation recoveries

not much people were a little sore three

or four days after the surgery, but it's not

without complications.

The largest trial ever

done 354 patients, number of complications or adverse events,

1.4%.

It gets them out of pain, it gets them

back to their daily activities of living,

it helps them be part of the community

again.

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

ever since.

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

patients.

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.

[Music.]

[Music.]

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

whole.

There are many FDA approved

osteoporosis medications and they can

come in oral, intravenous, or injectable

forms.

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

density.

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.

If someone

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.

I always

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

prevent.

There's a great handout on the

National Osteoporosis foundation website

that teaches people about some tips to

prevent Falls.

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

body.

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

paralysis.

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

[Music.]