Osteoporosis – Diagnosing and Treating

The most common method of diagnosing osteoporosis is via a DEXA (Dual Energy X-ray Absorptiometry) scan. Osteopenia, osteoporosis and severe osteoporosis are respectively defined as DEXA scan T scores of -1 to -2.5, less than -2.5 and less than -2.5 with a fragility fracture.

Vertebral compression fractures are the most common complication of osteoporosis at a cost of 10 to 15 billion dollars every year. There are approximately 700,000 vertebral compression fractures per year in the United States that result in spinal deformity (kyphosis/lordosis), acute/chronic pain, disability and reduced vital respiratory capacity. An osteoporotic vertebral compression fracture should be considered in anyone over the age of fifty with a complaint of acute or chronic back pain. The most common location for vertebral compression fractures are at the T7-8 and T12-L1 levels which correspond to the most mechanically compromised spine regions. The diagnostic work up for someone suspected of having a spinal compression fracture includes spine x-rays looking for wedged shaped vertebral fractures as well as MRI imaging with T2 and STIR sequences to evaluate the acuity of the fracture. Nuclear bone scans and CT can also be helpful in evaluating vertebral compression fractures.

Vertebral compression fractures lead to decreased physical function, restricted activities of daily living, sleep disturbances, early satiety, psychological disturbances and reduced pulmonary function. The subsequent risk of additional vertebral fractures increased after the first fracture. Women with a vertebral fracture had a >20% higher mortality rate adjusted for age. Patients with vertebral fractures are 2-3 times more likely to die of pulmonary causes typically due to COPD and pneumonia complications.

Kyphoplasty is a minimally invasive percutaneous procedure that restores vertebral body height, provides fracture stability and reduces pain associated with vertebral compression fractures. The procedure involves the placement of a balloon catheter through a needle introducer into the vertebral fracture, inflation of the balloon (which creates a cavity and restores vertebral body height) and injection of cement into the cavity. The indications for kyphoplasty include an osteoporotic or malignant spinal compression fracture, persistent back pain, progressive vertebral collapse, spinal deformity and a correct diagnosis from imaging studies. Contraindications consist of bone retropulsion with neurological complications, infection and greater than 80% loss of vertebral body height. Clinical studies have demonstrated that kyphoplasty is a highly effective treatment for compression fractures and provides correction of spinal deformities with significant pain relief, improved quality of life and increased physical function.