- Discussion:
- vertebral bodies are the skeletal elements most at risk of frx in this disease;
- progressive loss of stature results in progressive shortening of paraspinal
musculature which therefore requires more prolonged active contraction
for maintenance of posture (resulting in pain of muscle fatigue);
- this is the major cause of back pain in spinal osteoporosis;
- spinal compression fractures are insidious and are indicated only by modest back pain
early in the course of disease;
- vertebral frx occur more frequently in
type-I osteoporosis than
type II;
- Exam:
- spine itself is not tender;
- most patients indicate that pain is paraspinal;
- development of so-called dowager's hump in the upper thoracic spine;
- types of osteoporosis fractures:
- biconcave central compression fracture (lumbar spine)
- anterior wedge fracture (thoracic spine)
- symmetrical
transverse compression fracture;
- Radiographs:
- loss of horizontal trabeculae & thinning of cortices of vertebral end-plates,
which are finely delineated in contrast w/ fuzzy and indistinct markings;
- associated w/
osteomalacia or
hyperparathyroidism;
- in worst case of axial osteopenia, the intervertebral disc may appear
denser than vertebral body, producing confusing optical illusion;
- Treatment:
- pts who have back pain due to vertebral frx benefit from analgesic
drug therapy, PT, and orthopedic garment for back support;
- all should receive supplemental
calcium &
1,25(OH) Vit D;
- whether estrogren is indicated is controversial;
